Healthcare Provider Details

I. General information

NPI: 1669326930
Provider Name (Legal Business Name): HEATHER MCKEITHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 OLD LYNCH RD
PILOT MOUNTAIN NC
27041-8508
US

IV. Provider business mailing address

1230 OLD LYNCH RD STE 100
PILOT MOUNTAIN NC
27041-8508
US

V. Phone/Fax

Practice location:
  • Phone: 336-302-2368
  • Fax:
Mailing address:
  • Phone: 336-302-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: