Provider Demographics
NPI:1801575998
Name:HOWARD-GREEN, KEISHA (BSN, RN, CCO)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:HOWARD-GREEN
Suffix:
Gender:F
Credentials:BSN, RN, CCO
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KEISHA HOWARD-GREEN
Mailing Address - Street 1:405 SILVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-2326
Mailing Address - Country:US
Mailing Address - Phone:404-263-4084
Mailing Address - Fax:
Practice Address - Street 1:405 SILVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-2326
Practice Address - Country:US
Practice Address - Phone:404-263-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse