Provider Demographics
NPI:1093599953
Name:PRESTON, KEYARRA D
Entity Type:Individual
Prefix:
First Name:KEYARRA
Middle Name:D
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 WHITCOMB RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3103
Mailing Address - Country:US
Mailing Address - Phone:216-825-0045
Mailing Address - Fax:
Practice Address - Street 1:848 WHITCOMB RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3103
Practice Address - Country:US
Practice Address - Phone:216-825-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty