Individual
KEISHA L OLIPHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9421 EASTSIDE DRIVE EXT, NEWTON, MS 39330-0000
(601) 683-2031
(601) 683-0264
Mailing address
P O BOX 299, 9421 EASTSIDE DRIVE EXT, NEWTON, MS 39330-0000
(601) 683-2031
(601) 683-0264
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R861070
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R861070
MS BOARD OF NURSING
MS
Enumeration date
01/08/2009
Last updated
01/08/2009
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