Provider Demographics
NPI:1316475510
Name:KEYS, TINA RENEE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:KEYS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:RENEE
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4122 DRESSELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-1402
Mailing Address - Country:US
Mailing Address - Phone:314-277-3405
Mailing Address - Fax:314-376-5525
Practice Address - Street 1:4122 DRESSELL AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-1402
Practice Address - Country:US
Practice Address - Phone:314-277-3405
Practice Address - Fax:314-376-5525
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health