Provider Demographics
NPI:1508979212
Name:KEATON, REBECCA MARTIN (ARNP/CNM)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARTIN
Last Name:KEATON
Suffix:
Gender:F
Credentials:ARNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1213
Mailing Address - Country:US
Mailing Address - Phone:850-575-1700
Mailing Address - Fax:
Practice Address - Street 1:278 LASALLE LAFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5324
Practice Address - Country:US
Practice Address - Phone:850-875-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL587042367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife