Provider Demographics
NPI:1548040660
Name:MCKEITHAN, SUSANNE COURTNEY
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:COURTNEY
Last Name:MCKEITHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:MCKEITHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:113 RED LANE CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8005
Mailing Address - Country:US
Mailing Address - Phone:205-597-2155
Mailing Address - Fax:
Practice Address - Street 1:113 RED LANE CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8005
Practice Address - Country:US
Practice Address - Phone:205-597-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00233555376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide