Provider Demographics
NPI:1619735040
Name:KEATON, DESTINY S (FNP-C)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:S
Last Name:KEATON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17417 W LAKE HOUSTON PKWY APT 5106
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5169
Mailing Address - Country:US
Mailing Address - Phone:832-602-7920
Mailing Address - Fax:
Practice Address - Street 1:9180 PINECROFT DR STE 600
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3883
Practice Address - Country:US
Practice Address - Phone:281-296-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily