Provider Demographics
NPI:1962012591
Name:DRIVER, KEITH WAYNE (CARE MANAGER III)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:WAYNE
Last Name:DRIVER
Suffix:
Gender:M
Credentials:CARE MANAGER III
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 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-467-2010
Mailing Address - Fax:
Practice Address - Street 1:7351 SEMS LN
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9424
Practice Address - Country:US
Practice Address - Phone:707-972-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty