Provider Demographics
NPI:1427242254
Name:KEITH, BETTIE M (RN)
Entity type:Individual
Prefix:
First Name:BETTIE
Middle Name:M
Last Name:KEITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:189 SAMARITANS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2452
Mailing Address - Country:US
Mailing Address - Phone:336-526-8335
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-263-5666
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse