Provider Demographics
NPI:1750664934
Name:KEATING, CAROLYN ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:KEATING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALEDON CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3170
Mailing Address - Country:US
Mailing Address - Phone:864-232-7734
Mailing Address - Fax:864-232-7099
Practice Address - Street 1:17 CALEDON CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3170
Practice Address - Country:US
Practice Address - Phone:864-232-7734
Practice Address - Fax:864-232-7099
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3935363LW0102X
NC5004784363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health