Healthcare Provider Details

I. General information

NPI: 1609780725
Provider Name (Legal Business Name): DR. JAMESHA KEITHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 HIGHWAY 1 S
GREENVILLE MS
38701-5958
US

IV. Provider business mailing address

1732 ALABAMA DR
GREENVILLE MS
38703-2705
US

V. Phone/Fax

Practice location:
  • Phone: 662-332-1429
  • Fax:
Mailing address:
  • Phone: 662-822-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102593
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: