Provider Demographics
NPI:1013431535
Name:KEITH, CHRISTINA NANETTE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NANETTE
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4661 WINDBELL ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4960
Mailing Address - Country:US
Mailing Address - Phone:254-371-5514
Mailing Address - Fax:
Practice Address - Street 1:239 W BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2912
Practice Address - Country:US
Practice Address - Phone:254-542-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7139363LF0000X
TXAP135661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily