Provider Demographics
NPI:1952651853
Name:IORG, KESHIA ANN
Entity type:Individual
Prefix:MS
First Name:KESHIA
Middle Name:ANN
Last Name:IORG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939-0966
Mailing Address - Country:US
Mailing Address - Phone:307-780-7785
Mailing Address - Fax:
Practice Address - Street 1:3077 COUNTY RD. 241
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939-0966
Practice Address - Country:US
Practice Address - Phone:307-780-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator