Provider Demographics
NPI:1922702109
Name:EDSILL, KESHIA (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:EDSILL
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CREST DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2968
Mailing Address - Country:US
Mailing Address - Phone:712-577-0851
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY RD STE 224
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2346
Practice Address - Country:US
Practice Address - Phone:402-717-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH164918363LG0600X
NE114751363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology