Provider Demographics
NPI:1073532305
Name:VAN METER, KEITH W (ARNP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:VAN METER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST # 356158
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6158
Mailing Address - Country:US
Mailing Address - Phone:206-598-8412
Mailing Address - Fax:206-598-6986
Practice Address - Street 1:1959 NE PACIFIC ST # 356158
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6158
Practice Address - Country:US
Practice Address - Phone:206-548-8412
Practice Address - Fax:206-598-6986
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00068957163W00000X
WAAP30003468363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161862OtherLABOR & INDUSTRY
WA26859UOtherREGENCE BLUESHIELD
WA9634163Medicaid
WA0161862OtherLABOR & INDUSTRY
WAAB35491Medicare PIN