Provider Demographics
NPI:1518732304
Name:BOOKER-PHIFER, KATESHA V
Entity Type:Individual
Prefix:MS
First Name:KATESHA
Middle Name:V
Last Name:BOOKER-PHIFER
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 1:676 JANOS LN
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4164
Mailing Address - Country:US
Mailing Address - Phone:516-884-6328
Mailing Address - Fax:
Practice Address - Street 1:535 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7619
Practice Address - Country:US
Practice Address - Phone:516-385-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist