Provider Demographics
NPI:1700192531
Name:VILSAINT, KEISHA MONICE (PNP)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:MONICE
Last Name:VILSAINT
Suffix:
Gender:F
Credentials:PNP
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Other - Credentials:
Mailing Address - Street 1:340 MAGNOLIA CIRCLE
Mailing Address - Street 2:325TH MDOS/ 325TH MEDICAL GROUP TREATMENT FACILITY
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-5612
Mailing Address - Country:US
Mailing Address - Phone:850-283-7681
Mailing Address - Fax:850-283-7620
Practice Address - Street 1:340 MAGNOLIA CIRCLE
Practice Address - Street 2:325TH MDOS/ 325TH MEDICAL GROUP TREATMENT FACILITY
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5612
Practice Address - Country:US
Practice Address - Phone:850-283-7681
Practice Address - Fax:850-283-7620
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR164209363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics