Healthcare Provider Details

I. General information

NPI: 1366118549
Provider Name (Legal Business Name): KEESHA MARIE BELLAMY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE
LOS ANGELES CA
90027-6005
US

IV. Provider business mailing address

744 S FIGUEROA ST APT 2108
LOS ANGELES CA
90017-4835
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-3000
  • Fax:
Mailing address:
  • Phone: 504-568-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002403
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3380
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: