Provider Demographics
NPI:1730161290
Name:KEATON-BAIRD, KRISTY (NP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:KEATON-BAIRD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:KEATON BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:8765 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9583
Mailing Address - Country:US
Mailing Address - Phone:734-847-3802
Mailing Address - Fax:734-847-3418
Practice Address - Street 1:8765 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9583
Practice Address - Country:US
Practice Address - Phone:734-847-3802
Practice Address - Fax:734-847-3418
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08307-NP363LA2200X
MI4704192639363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02214OtherPARAMOUNT
OH2572201Medicaid
MI60886OtherHEALTH PLAN OF MICHIGAN
231807Medicare Oscar/Certification
MIE86031016Medicare PIN
BANP18471Medicare ID - Type UnspecifiedMEDICARE
OH02214OtherPARAMOUNT
OH2572201Medicaid