Provider Demographics
NPI:1588904353
Name:PROCTOR, KEREATHA (RN)
Entity type:Individual
Prefix:MRS
First Name:KEREATHA
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KEREATHA
Other - Middle Name:A
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-0970
Mailing Address - Country:US
Mailing Address - Phone:864-594-4400
Mailing Address - Fax:864-594-4406
Practice Address - Street 1:698 HOWARD ST
Practice Address - Street 2:SPARTANBURG SCHOOL DISTRICT 7 .
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-594-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30284163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool