Provider Demographics
NPI:1184258451
Name:MARSHALL, JUANISHA DE'SHA (APRN)
Entity type:Individual
Prefix:
First Name:JUANISHA
Middle Name:DE'SHA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 HELMSDALE PL APT 2107
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2442
Mailing Address - Country:US
Mailing Address - Phone:859-433-6418
Mailing Address - Fax:
Practice Address - Street 1:3050 HELMSDALE PL APT 2107
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2442
Practice Address - Country:US
Practice Address - Phone:859-433-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11442581363LF0000X
KY3015229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3015229OtherAPRN LICENSE