Provider Demographics
NPI:1275124851
Name:HARTFIELD, KESHIA L
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:L
Last Name:HARTFIELD
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:MC LAIN
Mailing Address - State:MS
Mailing Address - Zip Code:39456-0215
Mailing Address - Country:US
Mailing Address - Phone:601-408-1598
Mailing Address - Fax:
Practice Address - Street 1:9 CHARLES HARTFIELD RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT MS
Practice Address - State:MS
Practice Address - Zip Code:39423-0215
Practice Address - Country:US
Practice Address - Phone:601-408-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS898859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse