Provider Demographics
NPI:1770783862
Name:OLIVER, KESHIA ELAINE (DPM)
Entity type:Individual
Prefix:MISS
First Name:KESHIA
Middle Name:ELAINE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:PO BOX 291913
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0032
Mailing Address - Country:US
Mailing Address - Phone:803-828-3603
Mailing Address - Fax:803-828-3603
Practice Address - Street 1:4100 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:803-828-3603
Practice Address - Fax:803-828-3603
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC581OtherLICENSE NUMBER
SCAA2121Medicare UPIN