MEDICARE: KEISHA ROYLES

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	374U00000X	Home Health Aide
2	376J00000X	Homemaker
3	376K00000X	Nurse's Aide	401854710516	OH

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	:	1174064760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA ROYLES

Provider Business Mailing Address
First Line	:	873 OAKFIELD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1749
Country	:	US
Telephone Number	:	513-226-4077
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 OAKFIELD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1749
Country	:	US
Telephone Number	:	513-226-4077
Fax Number	:

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

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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Directions to “ KEISHA ROYLES ” Practice Location

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