Provider Demographics
NPI:1851024640
Name:ADAMS, KEISHA MAE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:MAE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14077 47TH LN NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-8617
Mailing Address - Country:US
Mailing Address - Phone:715-965-3814
Mailing Address - Fax:
Practice Address - Street 1:310 AIRPORT RD STE 2000
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-2959
Practice Address - Country:US
Practice Address - Phone:701-355-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR39382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily