Provider Demographics
NPI:1992018758
Name:KEATON, CATHY JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JO
Last Name:KEATON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 WASHINGTON NEW MARTINSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9500
Mailing Address - Country:US
Mailing Address - Phone:740-335-3776
Mailing Address - Fax:
Practice Address - Street 1:10981 WASHINGTON NEW MARTINSBURG RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9500
Practice Address - Country:US
Practice Address - Phone:740-335-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.093423-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse