Provider Demographics
NPI:1184445777
Name:MATHENY, KESHEIA BROOKE (NP)
Entity type:Individual
Prefix:
First Name:KESHEIA
Middle Name:BROOKE
Last Name:MATHENY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:WV
Mailing Address - Zip Code:25674-0044
Mailing Address - Country:US
Mailing Address - Phone:304-928-5421
Mailing Address - Fax:
Practice Address - Street 1:260 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1520
Practice Address - Country:US
Practice Address - Phone:606-437-7327
Practice Address - Fax:606-437-1401
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily