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General NPI Number Information
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NPI Number | 1639344179
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Entity Type | Individual
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Provider Name | KEITH ALAN FARRELL MS MPH APRN
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Gender | Male
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 555 E CHEVES STREET MCLEOD OCCUPATIONAL HEALTH
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City | FLORENCE
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State | SC
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Zip | 29506
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Country | US
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Telephone | 843-777-2550
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Fax | 843-777-5296
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Provider Business Mailing Address
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Address Line | 149 N RAVENEL STREET MCLEOD OCCUPATIONAL HEALTH
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City | FLORENCE
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State | SC
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Zip | 29506
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Country | US
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Telephone | 843-777-2550
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Fax | 843-777-5296
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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 | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 20020
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License Number State | SC
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