MEDICARE: GAGE KEATON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.0021309	OH
2	163W00000X	Registered Nurse	RN.463925	OH

General Provider Information

NPI Number	:	1770365660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAGE KEATON

Provider Business Mailing Address
First Line	:	4000 MONTICELLO BLVD APT 104
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1764
Country	:	US
Telephone Number	:	567-224-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 MONTICELLO BLVD APT 104
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1764
Country	:	US
Telephone Number	:	567-224-8211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	12/15/2025

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Directions to “ GAGE KEATON ” Practice Location

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