Healthcare Provider Details

I. General information

NPI: 1316929763
Provider Name (Legal Business Name): NANCY L. KEATON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 TWO BROOKS TRL
FLETCHER NC
28732-7443
US

IV. Provider business mailing address

PO BOX 1289 ASHBROOK RADIOLOGY
FLETCHER NC
28732-1289
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-2816
  • Fax: 828-684-2068
Mailing address:
  • Phone: 828-684-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9100869
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: