Healthcare Provider Details

I. General information

NPI: 1881557320
Provider Name (Legal Business Name): KEISHA PHILLIPS BARDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 CHURCH ST
ZACHARY LA
70791-3102
US

IV. Provider business mailing address

4192 HONEYSUCKLE DR
ZACHARY LA
70791-2765
US

V. Phone/Fax

Practice location:
  • Phone: 225-654-1175
  • Fax:
Mailing address:
  • Phone: 225-681-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberM4C3E2X9
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: