Provider Demographics
NPI:1699441949
Name:DOWDELL, KESHAWN C (CNA)
Entity type:Individual
Prefix:
First Name:KESHAWN
Middle Name:C
Last Name:DOWDELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CENTURY 21 DR APT H130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-7905
Mailing Address - Country:US
Mailing Address - Phone:904-568-0198
Mailing Address - Fax:
Practice Address - Street 1:401 CENTURY 21 DR APT H130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7905
Practice Address - Country:US
Practice Address - Phone:904-568-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health