Individual
LAKISHA PETEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
950 HWY 13 S, COLUMBIA, MS 39429
(601) 588-6689
Mailing address
107 WALTER PAYTON DR # 220, COLUMBIA, MS 39429-3738
(601) 588-6689
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
07/10/2023
Last updated
07/11/2023
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