Keith, Coretta D.

Keith, Coretta D. is an sole proprietor health care provider with primary practice located at 901 18Th St E , Tifton GA 31794-3648. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Keith, Coretta D. can be contacted via phone (229) 382-7120.

Contact Information

Primary practice address
901 18Th St E Tifton GA 31794-3648
Phone: (229) 382-7120
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP4450 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN124581 Georgia

Profile Details

NPI number 1306884374
LBN Legal business name Keith, Coretta D.
Credentials DNP, FNP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 3rd, 2006
Last updated May 4th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306884374 NPPES
Georgia Other P00266428 RAILROAD MEDICARE
Georgia MEDICAID 000927198E RAILROAD MEDICARE

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