Provider Demographics
NPI:1043774060
Name:ROSAMOND, KESHA LADAWN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:KESHA
Middle Name:LADAWN
Last Name:ROSAMOND
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:KESHA
Other - Middle Name:LADAWN
Other - Last Name:ROSAMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN- NP STUDENT
Mailing Address - Street 1:5930 E 31ST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5118
Mailing Address - Country:US
Mailing Address - Phone:918-332-0625
Mailing Address - Fax:
Practice Address - Street 1:5930 E 31ST ST STE 500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5118
Practice Address - Country:US
Practice Address - Phone:918-332-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209342163WC1500X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health