Provider Demographics
NPI:1447012158
Name:WASHINGTON, KEYISHA RENEE
Entity type:Individual
Prefix:
First Name:KEYISHA
Middle Name:RENEE
Last Name:WASHINGTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2121
Mailing Address - Country:US
Mailing Address - Phone:870-594-6001
Mailing Address - Fax:501-823-3623
Practice Address - Street 1:1220 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2121
Practice Address - Country:US
Practice Address - Phone:870-594-6001
Practice Address - Fax:501-823-3623
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR231065363LF0000X
ARR068013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse