Healthcare Provider Details

I. General information

NPI: 1093639437
Provider Name (Legal Business Name): KEISA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 KATHERINE DR
COLUMBUS OH
43232-5646
US

IV. Provider business mailing address

2116 MINNESOTA AVE
COLUMBUS OH
43211
US

V. Phone/Fax

Practice location:
  • Phone: 347-245-1588
  • Fax:
Mailing address:
  • Phone: 347-245-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: