Healthcare Provider Details

I. General information

NPI: 1558299156
Provider Name (Legal Business Name): SHANDY D KEATON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S OAKWOOD AVE
BECKLEY WV
25801-5927
US

IV. Provider business mailing address

PO BOX 334
GHENT WV
25843-0334
US

V. Phone/Fax

Practice location:
  • Phone: 304-575-0762
  • Fax: 304-575-0762
Mailing address:
  • Phone: 304-575-0762
  • Fax: 304-575-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: