Provider Demographics
NPI:1992140354
Name:ANTOINE-JENNINGS, KEISHA NADINE (RN)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:NADINE
Last Name:ANTOINE-JENNINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1112
Mailing Address - Country:US
Mailing Address - Phone:347-495-9987
Mailing Address - Fax:
Practice Address - Street 1:76 ESPLANADE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1112
Practice Address - Country:US
Practice Address - Phone:347-495-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641502-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse