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Individual

LAKIESHA BOHANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3600 SHIRE BLVD STE 104, RICHARDSON, TX 75082-2236
(972) 487-6400
Mailing address
3600 SHIRE BLVD STE 104, RICHARDSON, TX 75082-2236
(972) 487-6400

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA13729
TX

Other

Enumeration date
09/13/2016
Last updated
08/04/2020
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