Individual
KEISHIA HENDERSON MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
441 WALL BLVD, GRETNA, LA 70056-7723
(504) 371-6597
(504) 371-6555
Mailing address
441 WALL BLVD, GRETNA, LA 70056-7723
(504) 371-6597
(504) 371-6555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07067
LA
363LF0000X
Family Nurse Practitioner
RN117999
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2317679
—
LA
Enumeration date
09/06/2012
Last updated
03/29/2017
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