Individual
MRS. BEVERLY MARIE KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 BLASSINGAME RD, GREENVILLE, SC 29605-3304
(864) 355-1600
(864) 355-1625
Mailing address
100 BLASSINGAME RD, GREENVILLE, SC 29605-3304
(864) 355-1600
(864) 355-1625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P8482
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8435
EMPLOYEE ID
SC
Enumeration date
03/20/2013
Last updated
03/20/2013
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