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General NPI Number Information
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NPI Number | 1487919544
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Entity Type | Individual
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Provider Name | MICHELLE MARIE KEETER MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 550 E WASHINGTON BLVD
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8160
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Country | US
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Telephone | 707-465-6925
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Fax | 707-465-6070
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Provider Business Mailing Address
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Address Line | 670 9TH ST STE 203
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City | ARCATA
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State | CA
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Zip | 95521-6249
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Country | US
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Telephone | 707-826-8633
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Fax | 707-826-8638
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A130812
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License Number State | CA
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