Provider Demographics
NPI:1497991087
Name:KEATON, JOCELYN (LPN)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:KEATON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 TRIUMPH WAY
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2329
Mailing Address - Country:US
Mailing Address - Phone:614-383-7760
Mailing Address - Fax:
Practice Address - Street 1:344 TRIUMPH WAY
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2329
Practice Address - Country:US
Practice Address - Phone:614-383-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN132821-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse