Doctor Name: | EDWARD MARVIN MCKEITHAN |
NPI Number: | 1821295668 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | 105024 |
Business Practice Address: | 3875 Business 17 E Bolivia, NC - 284228666 |
Business Phone Number: | 9102537990 |
Business Fax Number: | |
Mailing Address: | Po Box 409, BOLIVIA |
State: | NC |
Postal Code: | 284220409 |
Phone Number: | 9102537990 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2007 |
NPI Last Update Date: | 10/29/2008 |
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: |