Provider Demographics
NPI:1366643728
Name:KEATON, BETTY J (BSN, RN, CRNA)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:KEATON
Suffix:
Gender:F
Credentials:BSN, RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-0250
Mailing Address - Country:US
Mailing Address - Phone:317-895-0582
Mailing Address - Fax:
Practice Address - Street 1:8060 KNUE RD STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1938
Practice Address - Country:US
Practice Address - Phone:317-842-7435
Practice Address - Fax:317-842-7674
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28053117A163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical