Healthcare Provider Details

I. General information

NPI: 1639043706
Provider Name (Legal Business Name): KEISHA AYANNA MCPHERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

808 ALBANY AVE
BROOKLYN NY
11203-3002
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-8775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number320108
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: