MEDICARE: KEESHA MCCLOUD

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1528717543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEESHA MCCLOUD

Provider Business Mailing Address
First Line	:	2869 CHALK MOUNTAIN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-1864
Country	:	US
Telephone Number	:	725-256-1108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2869 CHALK MOUNTAIN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-1864
Country	:	US
Telephone Number	:	725-256-1108
Fax Number	:

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

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	03/18/2022

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Directions to “ KEESHA MCCLOUD ” Practice Location

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