Provider Demographics
NPI:1851494850
Name:DUGGER, KEITH O (CRNA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:O
Last Name:DUGGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-1890
Mailing Address - Country:US
Mailing Address - Phone:828-757-5100
Mailing Address - Fax:828-757-6193
Practice Address - Street 1:321 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5720
Practice Address - Country:US
Practice Address - Phone:828-757-5100
Practice Address - Fax:828-757-6193
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052437Medicaid
NC2609391Medicare ID - Type Unspecified