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General NPI Number Information
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NPI Number | 1316592892
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Entity Type | Individual
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Provider Name | DEMETRA KEITH NP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 250 ARSENAL ST
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City | AUGUSTA
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State | ME
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Zip | 04330-5742
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Country | US
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Telephone | 207-624-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 6 NEWPORT CT
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City | YARMOUTH
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State | ME
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Zip | 04096-1549
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Country | US
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Telephone | 281-844-2593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP191199
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License Number State | ME
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