Provider Demographics
NPI:1982174306
Name:TOOLEY, KESHAWNA NICOLE
Entity Type:Individual
Prefix:
First Name:KESHAWNA
Middle Name:NICOLE
Last Name:TOOLEY
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 1:1642 N VOLUSIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-3850
Mailing Address - Country:US
Mailing Address - Phone:386-628-0295
Mailing Address - Fax:386-243-4581
Practice Address - Street 1:1642 N VOLUSIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3850
Practice Address - Country:US
Practice Address - Phone:386-628-0295
Practice Address - Fax:386-243-4581
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty