MEDICARE: KEYUNNA RUSSELL

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	2355S0801X	Speech-Language Assistant	44283	TX

General Provider Information

NPI Number	:	1821943960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYUNNA RUSSELL

Provider Business Mailing Address
First Line	:	2020 GRANDWAY DR APT 10307
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-0319
Country	:	US
Telephone Number	:	256-945-5727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 GRANDWAY DR APT 10307
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-0319
Country	:	US
Telephone Number	:	256-945-5727
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ KEYUNNA RUSSELL ” Practice Location

Language	Start Address	Practice Location

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