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NPI Code Detail

MEDICARE: KIESHA PADGETT LPN

MEDICARE: KIESHA PADGETT LPN
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
1164W00000XLicensed Practical NurseL52237AR

General Provider Information

NPI Number : 1790045029
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIESHA PADGETT LPN
Provider Business Mailing Address
First Line : 3307 N DIXIELAND RD
Second Line :
City : ROGERS
State : AR
Zip : 72756-6816
Country : US
Telephone Number : 479-986-5150
Fax Number :
Provider Business Practice Location Address
First Line : 3307 N DIXIELAND RD
Second Line :
City : ROGERS
State : AR
Zip : 72756-6816
Country : US
Telephone Number : 479-986-5150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 05/21/2012

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Directions to “ KIESHA PADGETT LPN” Practice Location

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