Provider Demographics
NPI:1972099844
Name:KEETON, JUSTIN (APRN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:KEETON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-880-9696
Practice Address - Fax:904-390-7452
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9336759363L00000X
FLARNP9336759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner