Provider Demographics
NPI:1477136315
Name:KEETER, TANYA WARD
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:WARD
Last Name:KEETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 KITLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6235
Mailing Address - Country:US
Mailing Address - Phone:828-545-8655
Mailing Address - Fax:
Practice Address - Street 1:9601 CHINA GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-9483
Practice Address - Country:US
Practice Address - Phone:980-293-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC159822163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool