Individual
KEISHA RENARDA JOHNSON-ROSEBORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1053 CENTER ST, WEST COLUMBIA, SC 29169-6749
(800) 491-0909
Mailing address
1053 CENTER ST, WEST COLUMBIA, SC 29169-6749
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26079
SC
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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