Provider Demographics
NPI:1730649450
Name:ABERNATHY, KEEGAN (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 PERSHING DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4436
Mailing Address - Country:US
Mailing Address - Phone:301-964-0292
Mailing Address - Fax:
Practice Address - Street 1:8001 KENNETT ST STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4881
Practice Address - Country:US
Practice Address - Phone:301-328-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4466133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist