Provider Demographics
NPI:1760626402
Name:KEITH, LINDA DALTON (FNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DALTON
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1099
Mailing Address - Country:US
Mailing Address - Phone:270-295-3890
Mailing Address - Fax:270-295-3891
Practice Address - Street 1:1704 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-826-4433
Practice Address - Fax:270-826-4222
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003103A363L00000X
KY3005994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner