Provider Demographics
NPI:1316461320
Name:BRIGHTMON, KEOSHA
Entity type:Individual
Prefix:
First Name:KEOSHA
Middle Name:
Last Name:BRIGHTMON
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 1:1221 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5455
Mailing Address - Country:US
Mailing Address - Phone:214-862-5426
Mailing Address - Fax:972-502-9181
Practice Address - Street 1:1221 HIGHVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5455
Practice Address - Country:US
Practice Address - Phone:214-862-5426
Practice Address - Fax:214-862-5426
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health