Individual
MR. MODIBO KEITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8908 PREAKNESS CIR, FORT WORTH, TX 76123-3582
(352) 870-7404
Mailing address
8908 PREAKNESS CIR, FORT WORTH, TX 76123-3582
(352) 870-7404
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
885241
TX
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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