Healthcare Provider Details

I. General information

NPI: 1144145632
Provider Name (Legal Business Name): KEYSHAWN MANAGAN LAWRENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 13TH ST
GERING NE
69341-2014
US

IV. Provider business mailing address

2402 W 15TH ST
SCOTTSBLUFF NE
69361-4212
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-2697
  • Fax:
Mailing address:
  • Phone: 308-632-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: