Healthcare Provider Details

I. General information

NPI: 1699695569
Provider Name (Legal Business Name): KEISHA DENESE BINES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 COPPERLINE DR
GARNER NC
27529-5944
US

IV. Provider business mailing address

736 COPPERLINE DR
GARNER NC
27529-5944
US

V. Phone/Fax

Practice location:
  • Phone: 919-521-2927
  • Fax:
Mailing address:
  • Phone: 919-521-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024198032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: