Provider Demographics
NPI:1689884652
Name:KEETON, NANCY ELISE (MED)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELISE
Last Name:KEETON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10259 W LANDMARK CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5483
Mailing Address - Country:US
Mailing Address - Phone:208-375-0265
Mailing Address - Fax:
Practice Address - Street 1:10259 W LANDMARK CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5483
Practice Address - Country:US
Practice Address - Phone:208-794-5349
Practice Address - Fax:208-375-0265
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional