Provider Demographics
NPI:1437411436
Name:KEITH, NADIRAH NAFEESAH (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NADIRAH
Middle Name:NAFEESAH
Last Name:KEITH
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 SOUTH BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5773
Practice Address - Country:US
Practice Address - Phone:704-316-3017
Practice Address - Fax:704-316-3018
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22265363LF0000X
NC5008317363LF0000X, 363L00000X
VA0024170039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily