Provider Demographics
NPI:1326225152
Name:KEETON, KAY (ACNP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:KEETON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:KAY
Other - Last Name:KEETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP
Mailing Address - Street 1:PO BOX 403631
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3631
Mailing Address - Country:US
Mailing Address - Phone:770-740-0895
Mailing Address - Fax:770-740-0896
Practice Address - Street 1:2626 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4402
Practice Address - Country:US
Practice Address - Phone:850-325-5885
Practice Address - Fax:850-325-7685
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2029502363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00746205OtherRAILROAD MEDICARE
FL3089151-00Medicaid
GA473115624AMedicaid
FLY122ZOtherBCBS
FLAJ083ZMedicare PIN
FL3089151-00Medicaid