Provider Demographics
NPI:1700186434
Name:KEETON, DEVIN ANTHONY (HS)
Entity Type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:ANTHONY
Last Name:KEETON
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 PINETREE ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4413
Mailing Address - Country:US
Mailing Address - Phone:609-892-3284
Mailing Address - Fax:
Practice Address - Street 1:759 PINETREE ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4413
Practice Address - Country:US
Practice Address - Phone:609-892-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider