Healthcare Provider Details

I. General information

NPI: 1033006994
Provider Name (Legal Business Name): CAROLYN KEITHLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W 1ST ST
SAINT FRANCIS KS
67756-3540
US

IV. Provider business mailing address

221 W 1ST ST
SAINT FRANCIS KS
67756-3540
US

V. Phone/Fax

Practice location:
  • Phone: 785-332-2682
  • Fax:
Mailing address:
  • Phone: 785-332-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-156327-041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: