Provider Demographics
NPI:1356744585
Name:KEYSE, GRETCHEN (CNP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:KEYSE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N 4TH ST
Mailing Address - Street 2:PO BOX 637
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3713
Mailing Address - Country:US
Mailing Address - Phone:479-229-2827
Mailing Address - Fax:479-229-5749
Practice Address - Street 1:215 N 4TH ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3713
Practice Address - Country:US
Practice Address - Phone:479-229-2827
Practice Address - Fax:479-229-5749
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily