Provider Demographics
NPI:1598201717
Name:WEATHERSBY, KEONDA (MBA)
Entity Type:Individual
Prefix:
First Name:KEONDA
Middle Name:
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3053
Mailing Address - Country:US
Mailing Address - Phone:504-319-2528
Mailing Address - Fax:888-651-2597
Practice Address - Street 1:8080 CROWDER BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1077
Practice Address - Country:US
Practice Address - Phone:504-246-2454
Practice Address - Fax:888-651-2597
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health