Provider Demographics
NPI:1295455871
Name:MARSOLAN, KEISHA DANIELLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:DANIELLE
Last Name:MARSOLAN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 STATE HIGHWAY 155 N
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-6244
Mailing Address - Country:US
Mailing Address - Phone:903-452-0680
Mailing Address - Fax:
Practice Address - Street 1:405 MAGRILL ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6445
Practice Address - Country:US
Practice Address - Phone:903-833-9875
Practice Address - Fax:903-209-2875
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1095530363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health