Individual
DR. LAKEISHA RENAE CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1665 S GREEN ST, TUPELO, MS 38804-6556
(662) 377-2189
Mailing address
1665 S GREEN ST, TUPELO, MS 38804-6556
(662) 377-2189
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23963
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04003571
—
MS
Enumeration date
06/17/2013
Last updated
10/05/2017
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