Provider Demographics
NPI:1093530552
Name:KEETON, AMANDA (APRN, CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KEETON
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1496
Mailing Address - Country:US
Mailing Address - Phone:859-499-0717
Mailing Address - Fax:859-499-0926
Practice Address - Street 1:148 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1496
Practice Address - Country:US
Practice Address - Phone:859-499-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101036340Medicaid