Healthcare Provider Details

I. General information

NPI: 1669318648
Provider Name (Legal Business Name): KEYRISA GILLIES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 380871
BROOKLYN NY
11238-0871
US

IV. Provider business mailing address

PO BOX 380871
BROOKLYN NY
11238-0871
US

V. Phone/Fax

Practice location:
  • Phone: 718-825-6744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360009
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722432
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: