Keisha Musu Fully, LPN
Licensed Practical Nurse in Staten Island, NY. Individual provider (NPI-1).
NPI number1104773803
StatusActive
Last updated in NPPESMar 12, 2026
Details
- NPI
- 1104773803
- Entity type
- Individual (NPI-1)
- Name
- Ms. Keisha Musu Fully
- Credential
- LPN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 12, 2026
- Certification date
- Mar 12, 2026
- Last updated
- Mar 12, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 352421 | NY | Yes |
| 164W00000X | Licensed Practical Nurse | 26NP49873900 | NJ |
Practice location
180 Park Hill Ave Apt 5dStaten Island, NY 10304-4708
Phone 347-596-1489
Mailing address
180 Park Hill Ave Apt 5dStaten Island, NY 10304-4708
Phone 347-596-1489
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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