Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

MR. JACK LOGAN KEITH JR., PMHNP

Deactivated Sole Proprietor

MR. JACK LOGAN KEITH JR., PMHNP is a Psychiatric/Mental Health Nurse Practitioner healthcare provider located in UNIVERSITY PLACE, Washington. NPI 1982968210 is deactivated in the NPPES registry. Verify at CMS.

Psychiatric/Mental Health Nurse Practitioner · UNIVERSITY PLACE, WA

This NPI has been deactivated. The record was deactivated on January 15, 2020. Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated. Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.

Registration Details

NPI Number: 1982968210
Provider Type: Individual
Gender: Male
NPI Issued: Jul 2, 2012 (7.5382513661202 yrs)
Last Updated: Dec 3, 2025
Deactivated: Jan 15, 2020
Licenses: 202110580NP-PP (OR)

AP61193548 (WA)
Sole Proprietor: Yes

Practice Information

Address: 6102 84TH AVENUE CT W

UNIVERSITY PLACE, WA, 984674042
Browse WA providers · Browse ZIP 98467
Phone: 3608705411
Fax: 8884148151
Primary Specialty: Psychiatric/Mental Health Nurse Practitioner
363LP0808X
Additional Specialty: Psychiatric/Mental Health Nurse Practitioner

Other Psychiatric/Mental Health Nurse Practitioner Providers in UNIVERSITY PLACE, WA

Name	Credential	NPI
MRS. GLEE LYON	ARNP	1184621831
DR. BARBARA RIX	DNP	1962598441
MRS. VICKI LYNN GRIMES	ARNP	1548710551
LAURA WALKER	DNP, PMHNP	1548863012
LISA MARIE KOYKAR	APRN	1659948396
AYUB MWAURA	NP	1780354944

Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.