Provider Demographics
NPI:1437143161
Name:SWAINSTON, KEITH R (NP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:SWAINSTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0314
Mailing Address - Country:US
Mailing Address - Phone:208-895-6729
Mailing Address - Fax:208-855-5921
Practice Address - Street 1:1130 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1813
Practice Address - Country:US
Practice Address - Phone:208-895-6729
Practice Address - Fax:208-855-5921
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21058.315363LF0000X
IDNP-823A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily