Provider Demographics
NPI:1003628751
Name:KEOTA FAMILY PRACTICE
Entity type:Organization
Organization Name:KEOTA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-202-3843
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:IA
Mailing Address - Zip Code:52248-0138
Mailing Address - Country:US
Mailing Address - Phone:319-202-3843
Mailing Address - Fax:641-206-7991
Practice Address - Street 1:302 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:IA
Practice Address - Zip Code:52248-9402
Practice Address - Country:US
Practice Address - Phone:319-202-3843
Practice Address - Fax:641-206-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty