Provider Demographics
NPI:1255598058
Name:LIGHTFOOT, KEATREDGE RE'TONDA (ARNP)
Entity type:Individual
Prefix:
First Name:KEATREDGE
Middle Name:RE'TONDA
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KEATREDGE
Other - Middle Name:RE'TONDA
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 SHARONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-0342
Mailing Address - Country:US
Mailing Address - Phone:850-421-2101
Mailing Address - Fax:
Practice Address - Street 1:8002 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1603
Practice Address - Country:US
Practice Address - Phone:813-886-7673
Practice Address - Fax:813-792-7895
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9181344363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health