Provider Demographics
NPI:1053586735
Name:KECK, JOYCE R
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:R
Last Name:KECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 MADISON 3375
Mailing Address - Street 2:
Mailing Address - City:WITTER
Mailing Address - State:AR
Mailing Address - Zip Code:72776-8067
Mailing Address - Country:US
Mailing Address - Phone:479-232-5755
Mailing Address - Fax:
Practice Address - Street 1:652 MADISON 3375
Practice Address - Street 2:
Practice Address - City:WITTER
Practice Address - State:AR
Practice Address - Zip Code:72776-8067
Practice Address - Country:US
Practice Address - Phone:479-232-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167262783Medicaid