Individual
FELICIA DENISE KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 259-4435
Mailing address
PO BOX 2563, DALTON, GA 30722-2563
(706) 271-0100
(706) 270-0487
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN1178178
TN
163W00000X
Registered Nurse
RN135293
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
APN12242
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009911719
—
AL
05
—
3638020
—
TN
01
—
4156148
BLUE CROSS BLUE SHIELD TN
TN
05
—
457182117A
—
GA
05
—
8052757
—
NC
01
—
N421141
WELLCARE (GA MEDICAID)
GA
01
—
P00460064
RAILROAD MEDICARE
TN
Enumeration date
08/13/2006
Last updated
09/22/2014
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