MEDICARE: NEREA KEESEE L.AC., EAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	AC61094788	WA
2	171100000X	Acupuncturist	AC61094788	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093352312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEREA KEESEE L.AC., EAMP

Provider Business Mailing Address
First Line	:	6107 N ASTOR ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-8102
Country	:	US
Telephone Number	:	509-968-1679
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 N ASTOR ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-8102
Country	:	US
Telephone Number	:	509-957-9577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	04/08/2025

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