Provider Demographics
NPI:1235709494
Name:MAYFIELD, KEILA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KEILA
Other - Middle Name:
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 E. SUNFLOWER ROAD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2828
Mailing Address - Country:US
Mailing Address - Phone:662-843-3606
Mailing Address - Fax:662-846-1708
Practice Address - Street 1:810 E. SUNFLOWER ROAD
Practice Address - Street 2:SUITE 100A
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2828
Practice Address - Country:US
Practice Address - Phone:662-843-3606
Practice Address - Fax:662-846-1708
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily