Provider Demographics
NPI:1275134215
Name:GILLIESPIE, KEISHA LYNN
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:LYNN
Last Name:GILLIESPIE
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 1:638 LITTLE PETER CAVE RD
Mailing Address - Street 2:
Mailing Address - City:LOVELY
Mailing Address - State:KY
Mailing Address - Zip Code:41231-9029
Mailing Address - Country:US
Mailing Address - Phone:606-390-2158
Mailing Address - Fax:
Practice Address - Street 1:638 LITTLE PETER CAVE RD
Practice Address - Street 2:
Practice Address - City:LOVELY
Practice Address - State:KY
Practice Address - Zip Code:41231-9029
Practice Address - Country:US
Practice Address - Phone:606-390-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant