Provider Demographics
NPI:1235844804
Name:ADAMS, KEITH N (RN)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:N
Last Name:ADAMS
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 1:9173 WOODRUN PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5514
Mailing Address - Country:US
Mailing Address - Phone:910-813-7741
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD STE 16C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1907
Practice Address - Country:US
Practice Address - Phone:704-285-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9486816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse