Provider Demographics
NPI:1851999403
Name:CARTER, KEISHA REBEKAH
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:REBEKAH
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 COAL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COAL MOUNTAIN
Mailing Address - State:WV
Mailing Address - Zip Code:24823-7814
Mailing Address - Country:US
Mailing Address - Phone:304-785-3662
Mailing Address - Fax:
Practice Address - Street 1:6726 COAL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:COAL MOUNTAIN
Practice Address - State:WV
Practice Address - Zip Code:24823-7814
Practice Address - Country:US
Practice Address - Phone:304-785-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant