Provider Demographics
NPI:1427125947
Name:KEEVER, DANIELLE SURRELLS (NP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SURRELLS
Last Name:KEEVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:SURRELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-3960
Mailing Address - Fax:336-718-3998
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-718-3960
Practice Address - Fax:336-718-3998
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02194363L00000X
NC5002194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003959Medicaid
NC193344OtherMEDCOST
NC7110891OtherAETNA
NC193344OtherMEDCOST