Provider Demographics
NPI:1689328569
Name:RAIFORD, KEANDRE DESMOND
Entity Type:Individual
Prefix:
First Name:KEANDRE
Middle Name:DESMOND
Last Name:RAIFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WILSONS MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27593-0344
Mailing Address - Country:US
Mailing Address - Phone:919-464-6979
Mailing Address - Fax:
Practice Address - Street 1:11448 US 70 BUSINESS HWY W STE C
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2208
Practice Address - Country:US
Practice Address - Phone:919-464-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No376J00000XNursing Service Related ProvidersHomemaker