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General NPI Number Information
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NPI Number | 1467873034
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Entity Type | Individual
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Provider Name | JODY KEETON NP-C
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Gender | Male
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 10455 S DE ANZA BLVD
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City | CUPERTINO
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State | CA
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Zip | 95014-3011
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Country | US
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Telephone | 859-619-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E SAN FERNANDO ST APT. 516
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City | SAN JOSE
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State | CA
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Zip | 95112-7423
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Country | US
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Telephone | 859-619-1202
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23851
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License Number State | CA
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