Provider Demographics
NPI:1972275964
Name:HARRISON, KEYRA WASHINGTON
Entity Type:Individual
Prefix:MRS
First Name:KEYRA
Middle Name:WASHINGTON
Last Name:HARRISON
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 1:2156 WOODDALE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1404
Mailing Address - Country:US
Mailing Address - Phone:225-930-8058
Mailing Address - Fax:
Practice Address - Street 1:2156 WOODDALE BLVD STE 750
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1404
Practice Address - Country:US
Practice Address - Phone:225-930-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator