Provider Demographics
NPI:1912349804
Name:PATTON, KEYSHA COLLEEN (LPN)
Entity Type:Individual
Prefix:
First Name:KEYSHA
Middle Name:COLLEEN
Last Name:PATTON
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 1:2025 JERRY MURPHY RD APT 221
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1216
Mailing Address - Country:US
Mailing Address - Phone:470-257-3835
Mailing Address - Fax:
Practice Address - Street 1:1700 WHEELING ST # A-211M
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7211
Practice Address - Country:US
Practice Address - Phone:706-389-6789
Practice Address - Fax:706-227-7249
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061302164W00000X
GALPN061302164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse