Individual provider Active NPI

Lakeisha Davis, CRNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1629843214
Registry record updated Nov 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP028672 Issued in PA
Practice address
501 S 54TH St
Philadelphia, PA 19143-1900
Phone
(215) 748-9000
NPI assigned
Nov 24, 2023
Last updated
Nov 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP028672 PA Primary

Addresses

Primary practice location

501 S 54TH St
Philadelphia, PA 19143-1900

Mailing address

1335 Weaver St
Philadelphia, PA 19150-2230
Phone (267) 315-0499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240127000133 PA Practitioner - Nurse Practitioner 4486007325 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penndel Mental Health Center, Inc.Group PAC ID 0042293300, 9 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1517 Durham Rd
Penndel, PA 19047-5707
Phone (215) 752-1541

501 S 54TH St
Psychiatry Hup Cedar
Philadelphia, PA 19143-1900
Phone (215) 748-9000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group Current Accepting new patients
Penndel Mental Health Center, Inc. CurrentSince Dec 2, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 19, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Feb 19, 2024 Accepting new patients

Locations

2080 Cabot Blvd W
Ste 100
Langhorne, PA 19047
Phone (267) 587-2390

1517 Durham Rd
Penndel, PA 19047
Phone (215) 752-1541

501 S 54th St
Philadelphia, PA 19143
Phone (215) 581-2046

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1629843214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 WEAVER ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191502230",
            "telephone_number": "267-315-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S 54TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191431900",
            "telephone_number": "215-748-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "LAKEISHA",
        "credential": "CRNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-24",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP028672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.