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General NPI Number Information
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NPI Number | 1033997572
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Entity Type | Individual
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Provider Name | KEESHA WYNN CD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 2795 FIRETHORN AVE FL 32073
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City | ORANGE PARK
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State | FL
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Zip | 32073-1699
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Country | US
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Telephone | 772-713-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 2795 FIRETHORN AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-1699
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Country | US
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Telephone | 772-713-1880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | RN9169385
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License Number State | FL
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