Provider Demographics
NPI:1558118950
Name:AUTREY, KEISHA DAWN
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:DAWN
Last Name:AUTREY
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 1:96 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4625
Mailing Address - Country:US
Mailing Address - Phone:305-413-0683
Mailing Address - Fax:
Practice Address - Street 1:96 JOHN ST
Practice Address - Street 2:
Practice Address - City:SUMMERLAND KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4625
Practice Address - Country:US
Practice Address - Phone:305-413-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist