Provider Demographics
NPI:1225332539
Name:ROBY, KEYSHA C (KEYSHA ROBY)
Entity Type:Individual
Prefix:
First Name:KEYSHA
Middle Name:C
Last Name:ROBY
Suffix:
Gender:F
Credentials:KEYSHA ROBY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 NE ROAD RUNNER DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-1146
Mailing Address - Country:US
Mailing Address - Phone:580-492-4821
Mailing Address - Fax:580-492-4821
Practice Address - Street 1:264 NE ROAD RUNNER DR
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OK
Practice Address - Zip Code:73541-1146
Practice Address - Country:US
Practice Address - Phone:580-492-4821
Practice Address - Fax:580-492-4821
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator