Provider Demographics
NPI:1952557084
Name:ECKLES, KEITHA LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KEITHA
Middle Name:LYNN
Last Name:ECKLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 CHILDREN'S DRIVE
Mailing Address - Street 2:24 NICU - NNP PROGRAM
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-722-6510
Mailing Address - Fax:722-722-4772
Practice Address - Street 1:6001 EAST BROAD ST
Practice Address - Street 2:MOUNT CARMEL EAST HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-234-6590
Practice Address - Fax:614-234-9395
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA#NP-01893363L00000X
OHNCC#ECK1-0427-7390363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care