Provider Demographics
NPI:1336340801
Name:JETER, KEESHA M (DO)
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:M
Last Name:JETER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST, BB-1332
Mailing Address - Street 2:BOX 356524
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6524
Mailing Address - Country:US
Mailing Address - Phone:206-685-6120
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST, BB-1332
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6524
Practice Address - Country:US
Practice Address - Phone:206-685-6120
Practice Address - Fax:718-953-8753
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program