Provider Demographics
NPI:1760675953
Name:KEDDINGTON, LINDA LAVERNE (APRN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LAVERNE
Last Name:KEDDINGTON
Suffix:
Gender:F
Credentials:APRN
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 58621
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99711-0621
Mailing Address - Country:US
Mailing Address - Phone:406-579-7101
Mailing Address - Fax:
Practice Address - Street 1:315 5TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5025
Practice Address - Country:US
Practice Address - Phone:406-579-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30177363LP0808X
COAPN.0992259-NP363LP0808X
AK1373363LP0808X
OR201811259NP-PP364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty