Provider Demographics
NPI:1205639887
Name:TATE, KEYAUNDRIA (RN)
Entity type:Individual
Prefix:
First Name:KEYAUNDRIA
Middle Name:
Last Name:TATE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 LITTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-4500
Mailing Address - Country:US
Mailing Address - Phone:662-549-4732
Mailing Address - Fax:
Practice Address - Street 1:92 LITTLE CREEK LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-4500
Practice Address - Country:US
Practice Address - Phone:662-549-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse