Active NPI
Keisha Lavender, RN, DR.PH STU
- Registered Nurse
- Pasadena, CA
National Provider Identifier
1619629771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 71760
- Practice address
- 2650 E Foothill Blvd
Pasadena, CA 91107-3439 - Phone
- (626) 577-2261
- NPI assigned
- Jan 20, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 71760 | CA | Primary |
Addresses
Primary practice location
2650 E Foothill Blvd
Pasadena, CA 91107-3439
Mailing address
1822 E Route 66
Glendora, CA 91740-3801
Phone (424) 324-8503
Other practice location 1
845 E Arrow Hwy
Pomona, CA 91767-2535
Phone (909) 624-1233 ext. 2637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71760 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642636800000",
"number": "1619629771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1822 E ROUTE 66",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917403801",
"telephone_number": "424-324-8503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 E FOOTHILL BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911073439",
"telephone_number": "626-577-2261"
}
],
"practiceLocations": [
{
"address_1": "845 E Arrow Hwy",
"address_purpose": "LOCATION",
"city": "Pomona",
"state": "CA",
"postal_code": "917672535",
"country_code": "US",
"telephone_number": "909-624-1233 x2637",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LAVENDER",
"first_name": "KEISHA",
"credential": "RN, DR.PH STU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-20",
"last_updated": "2022-01-20",
"certification_date": "2022-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "71760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.