Provider Demographics
NPI:1609583129
Name:TILLARD, KEYONNA (CRT, CRT-SDS)
Entity Type:Individual
Prefix:
First Name:KEYONNA
Middle Name:
Last Name:TILLARD
Suffix:
Gender:F
Credentials:CRT, CRT-SDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BELTON LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1532
Mailing Address - Country:US
Mailing Address - Phone:951-834-4179
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE STE 420
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4352
Practice Address - Country:US
Practice Address - Phone:702-227-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care