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General NPI Number Information
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NPI Number | 1003628751
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Entity Type | Organization
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Legal Business Name | KEOTA FAMILY PRACTICE
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 302 E BROADWAY AVE
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City | KEOTA
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State | IA
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Zip | 52248-9402
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Country | US
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Telephone | 319-383-7044
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Fax | 833-740-3624
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Provider Business Mailing Address
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Address Line | PO BOX 138
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City | KEOTA
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State | IA
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Zip | 52248-0138
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Country | US
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Telephone | 319-383-7044
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Fax | 833-740-3624
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE K MORGAN
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Credential | ARNP
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Telephone | 319-202-3843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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