Provider Demographics
NPI:1972117992
Name:MARTIN, KEI (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:KEI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3711
Mailing Address - Country:US
Mailing Address - Phone:949-594-0446
Mailing Address - Fax:
Practice Address - Street 1:140 CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3711
Practice Address - Country:US
Practice Address - Phone:949-594-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily