Provider Demographics
NPI:1427565183
Name:AMBROSE, KESHA DENA
Entity type:Individual
Prefix:
First Name:KESHA
Middle Name:DENA
Last Name:AMBROSE
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 1:2211 TRINIDAD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-2751
Mailing Address - Country:US
Mailing Address - Phone:708-228-0308
Mailing Address - Fax:
Practice Address - Street 1:2211 TRINIDAD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-2751
Practice Address - Country:US
Practice Address - Phone:708-228-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2025-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX975404163W00000X
IL041380607163W00000X
IN28199135163W00000X
TN290289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse