Provider Demographics
NPI:1578315743
Name:KEITH, VICKI C
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:C
Last Name:KEITH
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 1:9136 GLOECKNER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9274
Mailing Address - Country:US
Mailing Address - Phone:513-403-5160
Mailing Address - Fax:
Practice Address - Street 1:1109 MADELEINE CR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-485-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide