Individual
AYESHA LATIFAH LACKNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8545 LEITH AVE, SAINT LOUIS, MO 63134-3223
(314) 347-7299
Mailing address
8545 LEITH AVE, SAINT LOUIS, MO 63134-3223
(314) 347-7299
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2025006595
MO
363LG0600X
Gerontology Nurse Practitioner
20255006595
MO
Other
Enumeration date
03/08/2025
Last updated
01/11/2026
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