Provider Demographics
NPI:1154095347
Name:KEATON, CIERRA Z (RN)
Entity Type:Individual
Prefix:MS
First Name:CIERRA
Middle Name:Z
Last Name:KEATON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 SIERRA AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7593
Mailing Address - Country:US
Mailing Address - Phone:323-383-5622
Mailing Address - Fax:
Practice Address - Street 1:20948 ONAKNOLL DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-7872
Practice Address - Country:US
Practice Address - Phone:949-228-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA740974163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management