Provider Demographics
NPI:1841956729
Name:WILLIAMS, KEISHA F (LPN)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:F
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BEACH 98TH STREET APT 5M
Mailing Address - Street 2:ROCKAWAY PARK
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:646-399-6573
Mailing Address - Fax:
Practice Address - Street 1:934 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5928
Practice Address - Country:US
Practice Address - Phone:718-389-8585
Practice Address - Fax:718-383-4014
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326616164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse