Basic Information
| Provider Information | |||||||||
| NPI: | 1609045269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEATON | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MCDOWELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE PRACTITIONER | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KEATON | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | MCDOWELL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSN, RSN, FNP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 404 SOUTH SUTHERLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042919267 | ||||||||
| FaxNumber: | 7042837939 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 WEST INNES STREET | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281444152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046375544 | ||||||||
| FaxNumber: | 7046371989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0050-03870 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 133760 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.