Provider Demographics
NPI:1376164608
Name:HARDING, KESHAUN NECOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KESHAUN
Middle Name:NECOLE
Last Name:HARDING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1004
Mailing Address - Country:US
Mailing Address - Phone:708-802-2620
Mailing Address - Fax:
Practice Address - Street 1:3742 BEECH ST
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1004
Practice Address - Country:US
Practice Address - Phone:708-802-2620
Practice Address - Fax:844-230-8586
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041387946163W00000X
IL209.021293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse