Provider Demographics
NPI:1033674635
Name:KEATON, BROOKLYN ELIZABETH
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:ELIZABETH
Last Name:KEATON
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 1:8795 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-9760
Mailing Address - Country:US
Mailing Address - Phone:614-378-0374
Mailing Address - Fax:
Practice Address - Street 1:8795 THOMAS LN
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-9760
Practice Address - Country:US
Practice Address - Phone:614-378-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program