MEDICARE: KEYSHIRA MONEE KEELING

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1164398194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYSHIRA MONEE KEELING

Provider Business Mailing Address
First Line	:	830 KUHN DR UNIT 211423
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91921-8058
Country	:	US
Telephone Number	:	619-392-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 BLUESTONE CIR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-4001
Country	:	US
Telephone Number	:	619-392-4485
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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