Provider Demographics
NPI:1093324717
Name:KEE, LAQUINTA PEELER (PHMNP-BC)
Entity Type:Individual
Prefix:
First Name:LAQUINTA
Middle Name:PEELER
Last Name:KEE
Suffix:
Gender:F
Credentials:PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CEDAR POINT DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-8116
Mailing Address - Country:US
Mailing Address - Phone:980-636-4015
Mailing Address - Fax:
Practice Address - Street 1:112 E DIXON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6703
Practice Address - Country:US
Practice Address - Phone:704-419-9772
Practice Address - Fax:980-522-9106
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018079736163WP0808X
NC2019080923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health