Provider Demographics
NPI:1073350062
Name:KEESEE, STEVEN FORD
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:FORD
Last Name:KEESEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 E RAINES RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-8331
Mailing Address - Country:US
Mailing Address - Phone:901-650-5705
Mailing Address - Fax:
Practice Address - Street 1:486 E RAINES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-8331
Practice Address - Country:US
Practice Address - Phone:901-650-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN079384984347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle