Provider Demographics
NPI:1003235284
Name:BALLENTINE-CARGILL, KEISHA A (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:A
Last Name:BALLENTINE-CARGILL
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 1:1054 E 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4806
Mailing Address - Country:US
Mailing Address - Phone:718-652-6791
Mailing Address - Fax:
Practice Address - Street 1:841 BURKE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6619
Practice Address - Country:US
Practice Address - Phone:718-654-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338198-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily