Provider Demographics
NPI:1942559364
Name:SAUNDERS, KEISHA R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:R
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HUNDLEY ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2489
Mailing Address - Country:US
Mailing Address - Phone:304-320-7595
Mailing Address - Fax:
Practice Address - Street 1:RR 103 SUPPLY STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836-0507
Practice Address - Country:US
Practice Address - Phone:304-448-2101
Practice Address - Fax:304-448-3217
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002725664OtherHIGHMARK BCBS
WV3810024326Medicaid
WVWV1854AMedicare PIN
WV3810024326Medicaid
WVWV1854BMedicare PIN