Healthcare Provider Details

I. General information

NPI: 1114866340
Provider Name (Legal Business Name): LYNETTA KEYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 RACHEL ST NW APT 10
CANTON OH
44709-2880
US

IV. Provider business mailing address

1459 RACHEL ST NW APT 10
CANTON OH
44709-2880
US

V. Phone/Fax

Practice location:
  • Phone: 234-521-1357
  • Fax:
Mailing address:
  • Phone: 234-521-1357
  • 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: