Provider Demographics
NPI:1952137747
Name:KEITA, KHADIJA MARIAMA (RN)
Entity type:Individual
Prefix:MS
First Name:KHADIJA
Middle Name:MARIAMA
Last Name:KEITA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 RADCLIFFE RD # B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-1627
Mailing Address - Country:US
Mailing Address - Phone:859-382-3848
Mailing Address - Fax:
Practice Address - Street 1:387 RADCLIFFE RD # B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-1627
Practice Address - Country:US
Practice Address - Phone:859-382-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4003041163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice