Keesha McCloud
Prosthetic/Orthotic Supplier in Las Vegas, NV. Individual provider (NPI-1).
NPI number1528717543
StatusActive
Last updated in NPPESMar 18, 2022
Details
- NPI
- 1528717543
- Entity type
- Individual (NPI-1)
- Name
- Keesha McCloud
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 18, 2022
- Certification date
- Mar 18, 2022
- Last updated
- Mar 18, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | – | – | Yes |
Other names
- Keesha Wallace (Former Name)
Practice location
2869 Chalk Mountain CtLas Vegas, NV 89142-1864
Phone 725-256-1108
Mailing address
2869 Chalk Mountain CtLas Vegas, NV 89142-1864
Phone 725-256-1108
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