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General NPI Number Information
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NPI Number | 1821295668
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Entity Type | Individual
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Provider Name | EDWARD MARVIN MCKEITHAN NP
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3971 BUSINESS 17 E
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City | BOLIVIA
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State | NC
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Zip | 28422-8675
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Country | US
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Telephone | 910-500-6451
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Fax | 910-500-6458
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Provider Business Mailing Address
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Address Line | 3971 BUSINESS 17 E
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City | BOLIVIA
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State | NC
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Zip | 28422-8675
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Country | US
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Telephone | 910-500-6451
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Fax | 910-500-6458
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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 | 105024
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License Number State | NC
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