Organization
KESHA HEALTH CARE SERVICE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAKESHA SHONEASE YOUNG (OWNER)
(863) 595-6212
Entity
Organization
Contact information
Practice address
135 MANSEAU DR, WINTER HAVEN, FL 33880-1719
(863) 595-6212
Mailing address
135 MANSEAU DR, WINTER HAVEN, FL 33880-1719
(863) 595-6212
(863) 875-4742
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
001447200
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001447200
—
FL
05
—
001447201
—
FL
05
—
003167300
—
FL
Enumeration date
04/11/2011
Last updated
04/11/2011
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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