MEDICARE: MARCQUISHA KEITA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1098513	TX

General Provider Information

NPI Number	:	1053196691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCQUISHA KEITA FNP

Provider Business Mailing Address
First Line	:	600 W 6TH ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2849
Country	:	US
Telephone Number	:	214-516-7850
Fax Number	:	817-260-0083

Provider Business Practice Location Address
First Line	:	600 W 6TH ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2849
Country	:	US
Telephone Number	:	214-516-7850
Fax Number	:	817-260-0083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	01/10/2026

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