Basic Information
Provider Information
NPI: 1003016783
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEATON
FirstName: MEAGAN
MiddleName: EMILY
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 916 S 3RD ST
Address2:  
City: MOUNT VERNON
State: WA
PostalCode: 982734324
CountryCode: US
TelephoneNumber: 3603365658
FaxNumber: 3603365655
Practice Location
Address1: 916 S 3RD ST
Address2:  
City: MOUNT VERNON
State: WA
PostalCode: 982734324
CountryCode: US
TelephoneNumber: 3603365658
FaxNumber: 3603365655
Other Information
ProviderEnumerationDate: 07/20/2007
LastUpdateDate: 04/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP60550856WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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