Provider Demographics
NPI:1073970539
Name:KEATTS, COURTNEY S (AGNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:KEATTS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7607 NC HIGHWAY 68 N STE B
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-8803
Practice Address - Country:US
Practice Address - Phone:336-643-5800
Practice Address - Fax:336-643-7474
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008319363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health