Provider Demographics
NPI:1275424954
Name:WILSON, KEYONA SHI ANN
Entity type:Individual
Prefix:
First Name:KEYONA
Middle Name:SHI ANN
Last Name:WILSON
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 1:1150 12TH ST NW APT 610
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4610
Mailing Address - Country:US
Mailing Address - Phone:202-677-8991
Mailing Address - Fax:
Practice Address - Street 1:2495 ALABAMA AVE SE UNIT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2790
Practice Address - Country:US
Practice Address - Phone:202-556-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant