Provider Demographics
NPI:1023896446
Name:KEATON, ASHTON OLIVIA (LAC)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:OLIVIA
Last Name:KEATON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLA VILLA DR
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-6702
Mailing Address - Country:US
Mailing Address - Phone:985-750-1886
Mailing Address - Fax:
Practice Address - Street 1:150 WILLA VILLA DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-6702
Practice Address - Country:US
Practice Address - Phone:985-750-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA337934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty