Provider Demographics
NPI:1124850169
Name:KEITH, EASTER
Entity type:Individual
Prefix:
First Name:EASTER
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 CORMIER DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-7607
Mailing Address - Country:US
Mailing Address - Phone:803-402-9087
Mailing Address - Fax:
Practice Address - Street 1:9005 TWO NOTCH RD STE 23
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5851
Practice Address - Country:US
Practice Address - Phone:803-402-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide