Provider Demographics
NPI:1366212276
Name:KEATON, SHANDA ANN (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:ANN
Last Name:KEATON
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58331 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-0506
Mailing Address - Country:US
Mailing Address - Phone:985-516-8050
Mailing Address - Fax:
Practice Address - Street 1:58331 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-0506
Practice Address - Country:US
Practice Address - Phone:985-516-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA96187363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health