Provider Demographics
NPI:1841996972
Name:TAYLOR, KEYUNNA
Entity type:Individual
Prefix:
First Name:KEYUNNA
Middle Name:
Last Name:TAYLOR
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 1:143 CADYCENTRE # 266
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1119
Mailing Address - Country:US
Mailing Address - Phone:313-204-3886
Mailing Address - Fax:
Practice Address - Street 1:390 GALE BLVD APT 2
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1762
Practice Address - Country:US
Practice Address - Phone:313-204-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide