Provider Demographics
NPI:1689485542
Name:HALE, KEEIANNA J (RN)
Entity type:Individual
Prefix:
First Name:KEEIANNA
Middle Name:J
Last Name:HALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 E CRAIG RD APT 1090
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7569
Mailing Address - Country:US
Mailing Address - Phone:661-470-8707
Mailing Address - Fax:
Practice Address - Street 1:2968 E RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2453
Practice Address - Country:US
Practice Address - Phone:702-791-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV878765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse