Basic Information
| Provider Information | |||||||||
| NPI: | 1043286354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | KEISHA | ||||||||
| MiddleName: | LACHANDA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63 FIRST COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299206343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432711118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2817 REILLY ROAD MCXC-COD CREDENTIALS | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA842 | SC | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 009349-1 | NY | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA9102468 | FL | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.