Healthcare Provider Details

I. General information

NPI: 1750834800
Provider Name (Legal Business Name): KEESHA HOLDEN-WHITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 S SALISBURY BLVD STE 1
SALISBURY MD
21801-7131
US

IV. Provider business mailing address

1410 S SALISBURY BLVD STE 1
SALISBURY MD
21801-7131
US

V. Phone/Fax

Practice location:
  • Phone: 443-944-9245
  • Fax:
Mailing address:
  • Phone: 410-845-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR163843
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR163843
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: