Provider Demographics
NPI:1851904171
Name:KEATON, BRANDON DAVID
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:KEATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 ODD RD.
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:WV
Mailing Address - Zip Code:25843
Mailing Address - Country:US
Mailing Address - Phone:304-575-5113
Mailing Address - Fax:
Practice Address - Street 1:1538 CHARLESTON AVE.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25843
Practice Address - Country:US
Practice Address - Phone:304-696-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program