Provider Demographics
NPI:1013685239
Name:TAYLOR, KEISHA (CNA)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5858
Mailing Address - Country:US
Mailing Address - Phone:702-325-6911
Mailing Address - Fax:
Practice Address - Street 1:2239 SUPERIOR POSITION ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3569
Practice Address - Country:US
Practice Address - Phone:702-504-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA024065376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide