Individual provider Active NPI

Heather Marie Keaton, FNP-C

  • Nurse Practitioner
  • Hollywood, FL
National Provider Identifier
1124780408
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95018668 Issued in CA
Practice address
200 S Park Rd Ste 200
Hollywood, FL 33021-8541
Phone
(760) 909-0539
NPI assigned
Oct 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95018668 CA Primary

Addresses

Primary practice location

200 S Park Rd Ste 200
Hollywood, FL 33021-8541

Mailing address

200 S Park Rd Ste 200
Hollywood, FL 33021-8541
Phone (760) 909-0539

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220910000443 CA Practitioner - Nurse Practitioner 6406231562 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wound Healing Care Specialists IncGroup PAC ID 5698019602, 9 clinicians

Practice addresses (Care Compare)

3536 Concours
Suite 225
Ontario, CA 91764-5585
Phone 90994404865585

Merit-based Incentive Payment System (MIPS)

Final score
78.03 of 100Reported as group
Quality
78.11
Improvement activities
40
Cost
33.57

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minghsun Liu, M.D., PC CurrentSince Aug 29, 2022 Accepting new patients
Rancho Wound Care Center, PC CurrentSince Aug 21, 2025 Accepting new patients
Wound Healing Care Specialists, Inc. CurrentSince Mar 8, 2023 Accepting new patients

Locations

11103 Venice Blvd
Los Angeles, CA 90034
Phone (310) 734-8526

3536 Concours
Ste 225
Ontario, CA 91764
Phone (314) 699-9181

11343 Base Line Rd
Rch Cucamonga, CA 91730

10621 Church St
Ste 120
Rch Cucamonga, CA 91730
Phone (909) 944-0481

25044 Peachland Ave
Ste 110
Santa Clarita, CA 91321

200 S Park Rd
Ste 200
Hollywood, FL 33021
Phone (866) 986-2263

Interoperability endpoints

  • Direct secure messaging: heather.keaton@247445671575556.direct.elationemr.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1124780408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S PARK RD STE 200",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218541",
            "telephone_number": "760-909-0539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S PARK RD STE 200",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218541",
            "telephone_number": "760-909-0539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEATON",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-13",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95018668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.