Healthcare Provider Details

I. General information

NPI: 1720700222
Provider Name (Legal Business Name): MISS KESHAUNNA MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 BUFFALO CT
COLUMBUS OH
43207-4052
US

IV. Provider business mailing address

295 BUFFALO CT
COLUMBUS OH
43207-4052
US

V. Phone/Fax

Practice location:
  • Phone: 614-817-5125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: