Healthcare Provider Details

I. General information

NPI: 1609738319
Provider Name (Legal Business Name): MRS. KEISHA N TRAMMELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 JARED PL
COLUMBUS OH
43219-5023
US

IV. Provider business mailing address

2812 JARED PL
COLUMBUS OH
43219-5023
US

V. Phone/Fax

Practice location:
  • Phone: 614-585-9214
  • Fax:
Mailing address:
  • Phone: 614-585-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: