Provider Demographics
NPI:1124008461
Name:KEYTON, VICTORIA LYNN (ANP-C)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:KEYTON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MS
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:KEYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-C
Mailing Address - Street 1:PO BOX 22062
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-2062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4830 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2089
Practice Address - Country:US
Practice Address - Phone:517-743-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550100NP363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704419902OtherMICHIGAN NURSING LICENSE (W/ NP CERTIFICATION)
OR200550100NPOtherNP STATE LICENSE
A0705150OtherBOARD CERTIFYING ORGANIZATION: AANP