Provider Demographics
NPI:1942713839
Name:GREGORY, DEKEYA (LPN)
Entity Type:Individual
Prefix:
First Name:DEKEYA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E 160TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7815
Mailing Address - Country:US
Mailing Address - Phone:718-401-5788
Mailing Address - Fax:718-401-4278
Practice Address - Street 1:760 E 160TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7815
Practice Address - Country:US
Practice Address - Phone:718-401-5788
Practice Address - Fax:718-401-4278
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269140164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse