Provider Demographics
NPI:1578075347
Name:PRAYLOW, KESHA JOHNSON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KESHA
Middle Name:JOHNSON
Last Name:PRAYLOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KESHA
Other - Middle Name:CHANTEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:131 HARBISON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2226
Mailing Address - Country:US
Mailing Address - Phone:034-858-1400
Mailing Address - Fax:
Practice Address - Street 1:PRISMA HEALTH URGENT CARE
Practice Address - Street 2:131 HARBISON BLVD, STE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212
Practice Address - Country:US
Practice Address - Phone:803-485-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5246Medicaid