Provider Demographics
NPI:1467770602
Name:KEEFER, CAROLYN JUNE (RD, CD, CNSD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JUNE
Last Name:KEEFER
Suffix:
Gender:F
Credentials:RD, CD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 W DESCHUTES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6705
Mailing Address - Country:US
Mailing Address - Phone:509-783-2273
Mailing Address - Fax:
Practice Address - Street 1:7325 W DESCHUTES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6705
Practice Address - Country:US
Practice Address - Phone:509-783-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00000152133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8462673Medicaid