Provider Demographics
NPI:1508572926
Name:KEYS, ANTWANETTE LAKEISHA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ANTWANETTE
Middle Name:LAKEISHA
Last Name:KEYS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3345
Mailing Address - Country:US
Mailing Address - Phone:662-588-9618
Mailing Address - Fax:
Practice Address - Street 1:221 W PARK AVE
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-3345
Practice Address - Country:US
Practice Address - Phone:662-588-9618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33484363L00000X
MS905875363L00000X
TN235216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner