Active NPI
Jonathan Latrell Keitt
- Peer Specialist
- Gastonia, NC
National Provider Identifier
1245094531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- M2024-11283-01
- Practice address
- 2020 Remount Rd Ste E112
Gastonia, NC 28054-7476 - Phone
- (704) 451-3878
- NPI assigned
- Feb 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | M2024-11283-01 | NC | Primary |
Addresses
Primary practice location
2020 Remount Rd Ste E112
Gastonia, NC 28054-7476
Mailing address
12109 Prails Mill LN
Charlotte, NC 28262-1586
Phone (704) 451-3878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M2024-11283-01 | NC | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1245094531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12109 PRAILS MILL LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282621586",
"telephone_number": "704-451-3878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 REMOUNT RD STE E112",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280547476",
"telephone_number": "704-451-3878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEITT",
"first_name": "JONATHAN",
"middle_name": "LATRELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-08",
"last_updated": "2024-02-08",
"certification_date": "2024-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NC",
"license": "M2024-11283-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.