KEATON PEAK (NPI# 1467017335) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467017335 |
| Entity Type | Individual |
| Full Name | KEATON PEAK |
| Practice Address |
1108 Ross Clark Cir Dothan AL 36301 |
| Mailing Address |
1419 Peak Rd Westville FL 32464-3072 |
| Practice Telephone | 3347938111 |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-09-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 1-147512 | AL | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | 1-147512 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1108 Ross Clark Cir, Dothan, AL 36301 | 3347938111 |
| Street Address |
1108 ROSS CLARK CIR |
| City | DOTHAN |
| State | AL |
| Zip Code | 36301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576268 | Judith L Bosse | Nurse Practitioner | 1108 Ross Clark Cir, Hospitalist Office, Dothan, AL 36301-3022 | 2005-05-27 |
| 1811597073 | Michael Brian Pierce | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-10-27 |
| 1659990901 | Robert Dale Garrett | Nurse Anesthetist, Certified Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-04-15 |
| 1861028607 | Richard Henry Jester | Physician Assistant | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-03-12 |
| 1396214060 | Shalita Clark | Psychiatry & Neurology | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-11-24 |
| 1619452760 | Drew Mckenzie Hubbard | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-09-25 |
| 1609359926 | Amber Salmon | Dietitian, Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-09-12 |
| 1255825832 | Shannon Louette Skaug | Nurse Practitioner | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-06-18 |
| 1225529712 | Vyshnavi Kone | Student in an Organized Health Care Education/Training Program | 1108 Ross Clark Cir, Dothan, AL 36301 | 2018-05-21 |
| 1811487549 | Sheila Elaine Starling | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-05-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043862931 | Pharmacy Center South LLC | Pharmacy | 2826 Ross Clark Circle, Suite 103, Dothan, AL 36301 | 2019-07-11 |
| 1851879167 | Attallah Cotton | Social Worker | 101 Eastridge Dr, Dothan, AL 36301 | 2018-07-31 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1750805818 | Kimberly Danielle Austin | Speech-Language Pathologist | 404 Darlington Cir, Dothan, AL 36301 | 2017-07-31 |
| 1952794885 | Lori P. Granberry | Pharmacist | 2131 Ross Clark Circle, Dothan, AL 36301 | 2015-03-17 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1720407646 | Michael Kreger | Anesthesiology | 1118 Ross Clark Cir Ste 700, Dothan, AL 36301 | 2014-04-08 |
| 1063851277 | Carlos Stanford Clark II | Family Medicine | 201 Doctors Drive, Dothan, AL 36301 | 2013-06-20 |
| 1639489313 | Robert Fort Hambaugh Jr. | Specialist | 712 Woodland Drive, Dothan, AL 36301 | 2010-10-15 |
| 1588894976 | Atwill Lamar Miller Jr. | Urology | 1908 Fairview Avenue, Dothan, AL 36301 | 2009-07-20 |
| Find all providers in zip 36301 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568095446 | Marathon Health LLC | Nurse Practitioner | 131 Cliff Rd, Dothan, AL 36303-5415 | 2020-02-19 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1902396286 | Genevieve Patricia Lewellyn | Nurse Practitioner | 1184 Upton Rd, Dothan, AL 36305-5134 | 2018-05-13 |
| 1073979886 | Sydney Stevens Weber | Nurse Practitioner | 1052 Ross Clark Cir, Dothan, AL 36303-5425 | 2016-01-08 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1013310143 | Samantha Poole Carter | Nurse Practitioner | 4300 W Main St Ste 15, Dothan, AL 36305-1058 | 2014-10-03 |
| 1760829881 | Michael Brent Nance | Nurse Practitioner | 4370 West Main Street, Dothan, AL 36305 | 2013-05-30 |
| 1144469438 | Houston County Healthcare Authority | Nurse Practitioner | 1806 Fairview Ave Ste A, Dothan, AL 36301-3026 | 2009-02-11 |
| 1851430383 | Robert Michael Ortiz | Nurse Practitioner | 1118 Ross Clark Cir Ste 303, Dothan, AL 36301-3002 | 2007-02-05 |
| 1841309648 | Malissa Harkleroad Williams | Nurse Practitioner | 3753 Ross Clark Cir, Suite 4, Dothan, AL 36303-2295 | 2006-08-29 |
| Find all providers in DOTHAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.