Provider Demographics
NPI:1639922495
Name:SANDERS, KESHIA AHSAKI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:AHSAKI
Last Name:SANDERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 ALLEN ST # 2110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1031
Mailing Address - Country:US
Mailing Address - Phone:601-807-6933
Mailing Address - Fax:
Practice Address - Street 1:1920 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6510
Practice Address - Country:US
Practice Address - Phone:817-442-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily