Provider Demographics
NPI:1942937818
Name:IRVIN, KEISHA RASHAUNE (RN)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:RASHAUNE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672151
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0036
Mailing Address - Country:US
Mailing Address - Phone:770-940-0388
Mailing Address - Fax:
Practice Address - Street 1:6690 ROSWELL RD STE 404
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3161
Practice Address - Country:US
Practice Address - Phone:470-888-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103058163W00000X
NY833865163W00000X
GARN250828163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse