Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60550856 | WA |
NPI | 1003016783 |
---|---|
Provider Name | Meagan Emily Keaton |
First Address | Mount Vernon, WA 98273-4324 |
Second Address | Mount Vernon, WA 98273-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 15/04/2015 |