Healthcare Provider Details

I. General information

NPI: 1548807100
Provider Name (Legal Business Name): KEANTHA BRANDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SNIDER RD
MASON OH
45040-2640
US

IV. Provider business mailing address

9519 TRIANGLE DR
WEST CHESTER OH
45011-8950
US

V. Phone/Fax

Practice location:
  • Phone: 513-223-3733
  • Fax:
Mailing address:
  • Phone: 513-356-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400365570504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: