Individual
MARY ANN A KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHA III
Contact information
Practice address
69 MOSES POINT ROAD, ELIM, AK 99739
(907) 890-3311
(907) 890-2280
Mailing address
69 MOSES POINT ROAD, ELIM, AK 99739
(907) 890-3311
(907) 890-2280
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
12-1168-III
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-1168-III
CHA III
AK
Enumeration date
01/30/2012
Last updated
01/30/2012
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