Provider Demographics
NPI:1831849694
Name:EARLE, KEYONNA A
Entity type:Individual
Prefix:MS
First Name:KEYONNA
Middle Name:A
Last Name:EARLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEYONNA
Other - Middle Name:A
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 LYONS DEN DR
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-2739
Mailing Address - Country:US
Mailing Address - Phone:240-292-9148
Mailing Address - Fax:
Practice Address - Street 1:2705 SHIPLEY TER SE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1824
Practice Address - Country:US
Practice Address - Phone:202-538-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant