Provider Demographics
NPI:1053128769
Name:CALLAHAN, KEISHA (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 HITCHCOCK RD
Mailing Address - Street 2:
Mailing Address - City:UVALDA
Mailing Address - State:GA
Mailing Address - Zip Code:30473-4015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:569 HITCHCOCK RD
Practice Address - Street 2:
Practice Address - City:UVALDA
Practice Address - State:GA
Practice Address - Zip Code:30473-4015
Practice Address - Country:US
Practice Address - Phone:912-585-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11240387OtherAMERICAN ACADEMY OF NURSE PRACTIONERS CERTIFYING BOARD-FAMILY NURSE PRACTIONER