Provider Demographics
NPI:1740725332
Name:DINKINS, KEESHA
Entity type:Individual
Prefix:
First Name:KEESHA
Middle Name:
Last Name:DINKINS
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 1:9209 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3152
Mailing Address - Country:US
Mailing Address - Phone:318-671-0271
Mailing Address - Fax:318-671-0271
Practice Address - Street 1:9209 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3152
Practice Address - Country:US
Practice Address - Phone:318-671-0271
Practice Address - Fax:318-671-0271
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist