Provider Demographics
NPI:1124303516
Name:KEITH, JANICE F (FNP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:F
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1001
Mailing Address - Country:US
Mailing Address - Phone:859-252-6500
Mailing Address - Fax:502-222-0029
Practice Address - Street 1:927 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1001
Practice Address - Country:US
Practice Address - Phone:859-252-6500
Practice Address - Fax:502-222-0029
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003580363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000792714OtherANTHEM PIN
KY78007572Medicaid
KY78007572Medicaid