Individual
LAKEISHA COLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1108 W INDIAN SCHOOL RD, STE B, PHOENIX, AZ 85013-3107
(602) 773-5600
(602) 773-5600
Mailing address
1108 W INDIAN SCHOOL RD, STE B, PHOENIX, AZ 85013-3107
(602) 773-5600
(602) 773-5600
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5716
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
980599
—
AZ
01
—
Z177769
PTAN
AZ
Enumeration date
05/26/2014
Last updated
10/01/2015
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