Provider Demographics
NPI:1164951174
Name:WARD, KEITH M (RN)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4489 ASHVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-4881
Mailing Address - Country:US
Mailing Address - Phone:850-556-9619
Mailing Address - Fax:
Practice Address - Street 1:4489 ASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-4881
Practice Address - Country:US
Practice Address - Phone:850-556-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2893762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse