Healthcare Provider Details

I. General information

NPI: 1942559364
Provider Name (Legal Business Name): KEISHA R SAUNDERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 103 SUPPLY STREET
GARY WV
24836-0507
US

IV. Provider business mailing address

133 HUNDLEY ST APT. 2
PRINCETON WV
24740-2489
US

V. Phone/Fax

Practice location:
  • Phone: 304-448-2101
  • Fax: 304-448-3217
Mailing address:
  • Phone: 304-320-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71622
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: