Provider Demographics
NPI:1467843466
Name:ARNOLD, KESHA
Entity Type:Individual
Prefix:
First Name:KESHA
Middle Name:
Last Name:ARNOLD
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 1:2825 30TH STREET ENSLEY
Mailing Address - Street 2:12
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-3700
Mailing Address - Country:US
Mailing Address - Phone:205-706-4722
Mailing Address - Fax:
Practice Address - Street 1:2825 30TH STREET ENSLEY
Practice Address - Street 2:12
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-3700
Practice Address - Country:US
Practice Address - Phone:205-706-4722
Practice Address - Fax:205-313-0228
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL677144374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide