Provider Demographics
NPI:1720376676
Name:KEATING, JEAN NMN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:NMN
Last Name:KEATING
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NATIONAL LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4911
Mailing Address - Country:US
Mailing Address - Phone:757-253-0572
Mailing Address - Fax:
Practice Address - Street 1:1620 OLD WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690-3910
Practice Address - Country:US
Practice Address - Phone:757-886-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166389364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health