Healthcare Provider Details

I. General information

NPI: 1609045269
Provider Name (Legal Business Name): LAURA MCDOWELL KEATON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MCDOWELL KEATON MSN, RSN, FNP-C

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 WEST INNES STREET
SALISBURY NC
28144-4152
US

IV. Provider business mailing address

404 SOUTH SUTHERLAND AVENUE
MONROE NC
28112-5060
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-5544
  • Fax: 704-637-1989
Mailing address:
  • Phone: 704-291-9267
  • Fax: 704-283-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-03870
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number133760
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: