Provider Demographics
NPI:1386962918
Name:KEITH, JARED N (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:N
Last Name:KEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SHADOWLINE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5022
Mailing Address - Country:US
Mailing Address - Phone:828-263-8707
Mailing Address - Fax:828-263-8710
Practice Address - Street 1:400 SHADOWLINE DR STE 203
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5022
Practice Address - Country:US
Practice Address - Phone:828-263-8707
Practice Address - Fax:828-263-8710
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.34085207RN0300X
NC2018-02062207RN0300X, 207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ073893Medicaid
LA2103202Medicaid
LA337088YM19Medicare PIN
AL102I392705Medicare PIN