Healthcare Provider Details

I. General information

NPI: 1003016783
Provider Name (Legal Business Name): MEAGAN EMILY KEATON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 HARBOUR VIEW BLVD STE B
SUFFOLK VA
23435-3760
US

IV. Provider business mailing address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

V. Phone/Fax

Practice location:
  • Phone: 757-337-4018
  • Fax: 577-337-4019
Mailing address:
  • Phone: 360-336-5658
  • Fax: 360-336-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167433
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: