Doctor Name: | KEIVA SANDLIN |
NPI Number: | 1114300464 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AGPCNP |
License Number: | 5007738 |
Business Practice Address: | 119 Crossover Rd Beulaville, NC - 285188801 |
Business Phone Number: | 9102983124 |
Business Fax Number: | |
Mailing Address: | 119 Crossover Rd, BEULAVILLE |
State: | NC |
Postal Code: | 285188801 |
Phone Number: | 9102983124 |
Fax Number: | |
NPI Enumeration Date: | 07/06/2015 |
NPI Last Update Date: | 07/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 5007738 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |