Provider Demographics
NPI:1306577002
Name:PURCELL, KESHANDA IESHA
Entity type:Individual
Prefix:
First Name:KESHANDA
Middle Name:IESHA
Last Name:PURCELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0946
Mailing Address - Country:US
Mailing Address - Phone:910-740-7326
Mailing Address - Fax:
Practice Address - Street 1:575 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1403
Practice Address - Country:US
Practice Address - Phone:910-740-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)