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General NPI Number Information
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NPI Number | 1467672204
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE NEPHROLOGY, P.A.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 400 SHADOWLINE DR STE 203
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City | BOONE
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State | NC
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Zip | 28607-5022
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Country | US
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Telephone | 828-263-8707
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Fax | 828-263-8710
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Provider Business Mailing Address
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Address Line | 400 SHADOWLINE DR STE 203
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City | BOONE
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State | NC
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Zip | 28607-5022
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Country | US
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Telephone | 828-263-8707
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Fax | 828-263-8710
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARED N KEITH
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Credential | MD
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Telephone | 828-263-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28557
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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