Provider Demographics
NPI:1639912512
Name:WHITTAKER-RIVERS, KESHIA LATRELL
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:LATRELL
Last Name:WHITTAKER-RIVERS
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 1:11595 WALKER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GAINESTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:36540-3075
Mailing Address - Country:US
Mailing Address - Phone:251-589-8216
Mailing Address - Fax:
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-791-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106025163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health