Provider Demographics
NPI:1871980730
Name:FORD, KEILAH B (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KEILAH
Middle Name:B
Last Name:FORD
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 CHAMPION FOREST DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-1883
Mailing Address - Country:US
Mailing Address - Phone:601-334-6858
Mailing Address - Fax:346-553-8456
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1883
Practice Address - Country:US
Practice Address - Phone:281-436-9444
Practice Address - Fax:346-553-8456
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127727363LF0000X, 363LP0808X
COC-RXN.0002130-C-NP363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily