Provider Demographics
NPI:1184081606
Name:FRAZIER, KESHAN ALYSE
Entity type:Individual
Prefix:MS
First Name:KESHAN
Middle Name:ALYSE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4211
Mailing Address - Country:US
Mailing Address - Phone:303-523-6714
Mailing Address - Fax:
Practice Address - Street 1:5332 ELKHART ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-4211
Practice Address - Country:US
Practice Address - Phone:303-523-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO305S00000XMedicaid
CO376J00000XMedicaid
CO253Z00000XMedicaid
CO347C00000XMedicaid
CO374U00000XMedicaid
CO376K00000XMedicaid
CO372600000XMedicaid
CO251E00000XMedicaid