Provider Demographics
NPI:1528752961
Name:COSSEY, KEANNA FAITH I
Entity type:Individual
Prefix:
First Name:KEANNA
Middle Name:FAITH
Last Name:COSSEY
Suffix:I
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 1:305 PRESTON DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-8506
Mailing Address - Country:US
Mailing Address - Phone:479-970-3804
Mailing Address - Fax:
Practice Address - Street 1:305 PRESTON DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-8506
Practice Address - Country:US
Practice Address - Phone:479-970-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)