Provider Demographics
NPI:1184483034
Name:HUBBARD, KEISHA
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-2079
Mailing Address - Country:US
Mailing Address - Phone:775-931-9165
Mailing Address - Fax:
Practice Address - Street 1:148 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2079
Practice Address - Country:US
Practice Address - Phone:775-931-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide