Healthcare Provider Details

I. General information

NPI: 1952794505
Provider Name (Legal Business Name): VALERIE ARIEL KECK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E WENDOVER AVE
GREENSBORO NC
27401-1205
US

IV. Provider business mailing address

1012 W BARTON ST APT A
GREENSBORO NC
27407-2918
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4444
  • Fax:
Mailing address:
  • Phone: 336-340-6954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number5007511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: