Provider Demographics
NPI:1043873276
Name:HAYES, KESHA LANETTE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KESHA
Middle Name:LANETTE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TOWNLEE LN STE D
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-8989
Mailing Address - Country:US
Mailing Address - Phone:803-713-5749
Mailing Address - Fax:803-753-9150
Practice Address - Street 1:20 TOWNLEE LN STE D
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8989
Practice Address - Country:US
Practice Address - Phone:803-713-5749
Practice Address - Fax:803-753-9150
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42996164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse