MEDICARE: KESHA JAMES 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	34697401	NY

General Provider Information

NPI Number	:	1134872526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESHA JAMES FNP

Provider Business Mailing Address
First Line	:	598 ASHFORD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-5602
Country	:	US
Telephone Number	:	718-594-5973
Fax Number	:

Provider Business Practice Location Address
First Line	:	13807 QUEENS BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-2641
Country	:	US
Telephone Number	:	516-750-0252
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	06/22/2022

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