Provider Demographics
NPI:1477311462
Name:ANDERSON, KESHIA TWANNA
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:TWANNA
Last Name:ANDERSON
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 1:424 27TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3744
Mailing Address - Country:US
Mailing Address - Phone:320-492-8876
Mailing Address - Fax:
Practice Address - Street 1:424 27TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3744
Practice Address - Country:US
Practice Address - Phone:320-492-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula