Provider Demographics
NPI:1598550162
Name:WITHERSPOON, KEYWANNA
Entity type:Individual
Prefix:
First Name:KEYWANNA
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KEYWANNA
Other - Middle Name:TYSHAE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-6348
Mailing Address - Country:US
Mailing Address - Phone:912-675-9384
Mailing Address - Fax:
Practice Address - Street 1:109 LAWSON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-6348
Practice Address - Country:US
Practice Address - Phone:912-675-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle