Provider Demographics
NPI:1801534532
Name:POTTS, KEIASHA LATAEY (GNA)
Entity type:Individual
Prefix:
First Name:KEIASHA
Middle Name:LATAEY
Last Name:POTTS
Suffix:
Gender:F
Credentials:GNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3949
Mailing Address - Country:US
Mailing Address - Phone:410-413-4382
Mailing Address - Fax:
Practice Address - Street 1:26 N PARK ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3949
Practice Address - Country:US
Practice Address - Phone:410-413-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00065128374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty