Provider Demographics
NPI:1871217919
Name:SMITH, KEISHA STARR
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:STARR
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 PRESTWICK PATH
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4803
Mailing Address - Country:US
Mailing Address - Phone:216-214-3877
Mailing Address - Fax:
Practice Address - Street 1:481 PRESTWICK PATH
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4803
Practice Address - Country:US
Practice Address - Phone:216-214-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health