Provider Demographics
NPI:1700214947
Name:SNOW, KEISHA L (APRN)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:L
Last Name:SNOW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:2605 KENTUCKY AVE STE 602
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3806
Practice Address - Country:US
Practice Address - Phone:270-442-4830
Practice Address - Fax:270-442-7667
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2020-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3008354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100277910Medicaid