Provider Demographics
NPI:1093487100
Name:ROWELL, KESHA RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:KESHA
Middle Name:RENEE
Last Name:ROWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KESHA
Other - Middle Name:RENEE
Other - Last Name:ROWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:120B MIDDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-4238
Mailing Address - Country:US
Mailing Address - Phone:843-260-6968
Mailing Address - Fax:
Practice Address - Street 1:120B MIDDLETON AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-4238
Practice Address - Country:US
Practice Address - Phone:843-260-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC248388163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty