Provider Demographics
NPI:1194222091
Name:BRAUGHTON, KEYEN MARCUS
Entity Type:Individual
Prefix:
First Name:KEYEN
Middle Name:MARCUS
Last Name:BRAUGHTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 SILVERLEAF LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-8496
Mailing Address - Country:US
Mailing Address - Phone:816-723-0408
Mailing Address - Fax:
Practice Address - Street 1:108 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2324
Practice Address - Country:US
Practice Address - Phone:660-543-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program