Healthcare Provider Details

I. General information

NPI: 1457121535
Provider Name (Legal Business Name): KEISHA YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 GREENBRIER PKWY STE 150
CHESAPEAKE VA
23320-0624
US

IV. Provider business mailing address

1403 GREENBRIER PKWY STE 150
CHESAPEAKE VA
23320-0624
US

V. Phone/Fax

Practice location:
  • Phone: 757-235-1760
  • Fax: 757-905-4636
Mailing address:
  • Phone: 757-235-1760
  • Fax: 757-905-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-0005197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: