Provider Demographics
NPI:1356553051
Name:KEILTY, MARY PRATT (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PRATT
Last Name:KEILTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WELWYN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2891
Mailing Address - Country:US
Mailing Address - Phone:803-749-7868
Mailing Address - Fax:
Practice Address - Street 1:25 WELWYN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2891
Practice Address - Country:US
Practice Address - Phone:803-749-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR57737163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine