Healthcare Provider Details

I. General information

NPI: 1134829690
Provider Name (Legal Business Name): MZ KEKE ANOINTED HANDS SALON AND HAIR REPLACEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 HACKS CROSS RD STE 114
OLIVE BRANCH MS
38654-3909
US

IV. Provider business mailing address

7721 HACKS CROSS RD STE 114
OLIVE BRANCH MS
38654-3909
US

V. Phone/Fax

Practice location:
  • Phone: 901-461-2756
  • Fax: 662-504-4234
Mailing address:
  • Phone: 901-461-2756
  • Fax: 662-504-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LAKITTA SHUNTEL BLACK
Title or Position: OWNER
Credential:
Phone: 901-461-2756