Provider Demographics
NPI:1952036212
Name:MCGLOTHIN, KEOSHA
Entity Type:Individual
Prefix:
First Name:KEOSHA
Middle Name:
Last Name:MCGLOTHIN
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 1:81 OLD ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39335-8337
Mailing Address - Country:US
Mailing Address - Phone:601-851-6002
Mailing Address - Fax:
Practice Address - Street 1:81 OLD ROCK RD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE
Practice Address - State:MS
Practice Address - Zip Code:39335-8337
Practice Address - Country:US
Practice Address - Phone:601-851-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program