Provider Demographics
NPI:1013456961
Name:NESMITH JACKSON, KESHIA MARIE (MSED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KESHIA
Middle Name:MARIE
Last Name:NESMITH JACKSON
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-1609
Mailing Address - Country:US
Mailing Address - Phone:757-338-1854
Mailing Address - Fax:
Practice Address - Street 1:303 CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-1609
Practice Address - Country:US
Practice Address - Phone:757-338-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist