Organization Name: | MCKEITHAN HEALTH, PA |
NPI Number: | 1811140494 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWARD M MCKEITHAN (OWNER) |
Mailing Address: | 3875 Business 17 E Bolivia |
State: | NC US |
Postal Code: | 284228666 |
Phone Number: | 9102537990 |
Fax Number: | |
NPI Enumeration Date: | 10/28/2008 |
NPI Last Update Date: | 08/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 105024 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |