Provider Demographics
NPI:1861243735
Name:PRINCE, KEIARIA (CNA)
Entity type:Individual
Prefix:
First Name:KEIARIA
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E TROY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2016
Mailing Address - Country:US
Mailing Address - Phone:313-610-3313
Mailing Address - Fax:
Practice Address - Street 1:1825 E TROY ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2016
Practice Address - Country:US
Practice Address - Phone:313-610-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X, 146D00000X, 171400000X, 172V00000X, 174H00000X, 175T00000X, 225100000X, 251F00000X, 251G00000X, 261QC1500X, 372500000X, 372600000X, 376K00000X, 385H00000X
MI0618202222861376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care