Healthcare Provider Details

I. General information

NPI: 1760319354
Provider Name (Legal Business Name): PRUDENCE BASTIEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEDDY-ADINE CHIQUINDA CREED RN

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MIMOSA ST
ROYAL PALM BEACH FL
33411-8004
US

IV. Provider business mailing address

105 MIMOSA ST
ROYAL PALM BEACH FL
33411-8004
US

V. Phone/Fax

Practice location:
  • Phone: 561-232-6158
  • Fax: 561-731-7236
Mailing address:
  • Phone: 561-232-6158
  • Fax: 561-731-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: