Jacob Keaton
Registered Nurse, Psych/Mental Health in Lewisburg, WV. Individual provider (NPI-1).
NPI number1164048229
StatusActive
Last updated in NPPESJun 24, 2020
Details
- NPI
- 1164048229
- Entity type
- Individual (NPI-1)
- Name
- Jacob Keaton
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 24, 2020
- Certification date
- Jun 24, 2020
- Last updated
- Jun 24, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WP0808X | Registered Nurse, Psych/Mental Health | 164w00000x | WV | Yes |
| 106E00000X | Assistant Behavior Analyst | – | – | |
| 373H00000X | Day Training/Habilitation Specialist | – | – |
Practice location
348 Northridge DrLewisburg, WV 24901-0010
Phone 304-661-3825
Mailing address
962 Coffman Cemetery RdLewisburg, WV 24901-5629
Phone 304-661-3825
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