Provider Demographics
NPI:1871251603
Name:CULBRETH, KEISHA MARIE
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:MARIE
Last Name:CULBRETH
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 1:103 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3107
Mailing Address - Country:US
Mailing Address - Phone:304-406-3132
Mailing Address - Fax:
Practice Address - Street 1:103 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3107
Practice Address - Country:US
Practice Address - Phone:304-406-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant