Individual
KEATON PEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301
(334) 793-8111
Mailing address
1419 PEAK RD, WESTVILLE, FL 32464-3072
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-147512
AL
363L00000X
Nurse Practitioner
Primary
1-147512
AL
Other
Enumeration date
05/07/2019
Last updated
09/11/2019
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