Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 5007511 | NC |
NPI | 1952794505 |
---|---|
Provider Name | Mrs. Valerie Ariel Keck |
First Address | Greensboro, NC 27407-2918 |
Second Address | Greensboro, NC 27401-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2015 |
Last Update Date | 06/03/2015 |