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General NPI Number Information
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NPI Number | 1700420700
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Entity Type | Organization
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Legal Business Name | KEISHA A BALLENTINE-CARGILL NP IN FAMILY HEALTH, P.C.
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1054 E 231ST ST
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City | BRONX
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State | NY
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Zip | 10466-4806
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Country | US
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Telephone | 914-882-7192
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Fax |
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Provider Business Mailing Address
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Address Line | 1054 E 231ST ST
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City | BRONX
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State | NY
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Zip | 10466-4806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. KEISHA ALETHEA BALLENTINE-CARGILL
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Credential | DNP, FNP-BC
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Telephone | 914-882-7192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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