Provider Demographics
NPI:1225735533
Name:DOUBET, KEITH MICHAEL (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:DOUBET
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HAWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:GILSON
Mailing Address - State:IL
Mailing Address - Zip Code:61436-9600
Mailing Address - Country:US
Mailing Address - Phone:309-251-3380
Mailing Address - Fax:
Practice Address - Street 1:3375 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:309-343-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty