Provider Demographics
NPI:1992078703
Name:KEELING, EBARA T (BA)
Entity type:Individual
Prefix:MRS
First Name:EBARA
Middle Name:T
Last Name:KEELING
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 JENNIFER ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-4918
Mailing Address - Country:US
Mailing Address - Phone:985-446-5244
Mailing Address - Fax:985-446-5478
Practice Address - Street 1:102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3004
Practice Address - Country:US
Practice Address - Phone:985-446-5244
Practice Address - Fax:985-446-5478
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator