Provider Demographics
NPI:1891377073
Name:KEITH, ELIZABETH A (RN, NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KEITH
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 NW ROANRIDGE RD APT H
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1385
Mailing Address - Country:US
Mailing Address - Phone:913-526-2893
Mailing Address - Fax:
Practice Address - Street 1:7835 NW ROANRIDGE RD APT H
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1385
Practice Address - Country:US
Practice Address - Phone:913-526-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023078163W00000X
MO2020025762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse