Healthcare Provider Details

I. General information

NPI: 1124008461
Provider Name (Legal Business Name): VICTORIA LYNN KEYTON ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TORI KEYTON ANP-C

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 CENTRAL PARK DR
OKEMOS MI
48864-2089
US

IV. Provider business mailing address

PO BOX 22062
LANSING MI
48909-2062
US

V. Phone/Fax

Practice location:
  • Phone: 517-743-0879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number200550100NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200550100NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: