Provider Demographics
NPI:1053129452
Name:RHODES, KEINISHIA Y
Entity type:Individual
Prefix:
First Name:KEINISHIA
Middle Name:Y
Last Name:RHODES
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 1:183 BRIGHT IBIS AVE
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3548
Mailing Address - Country:US
Mailing Address - Phone:314-461-8130
Mailing Address - Fax:
Practice Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6260
Practice Address - Country:US
Practice Address - Phone:813-289-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician