| Doctor Name: | MANDY GAYLE KEOWN |
| NPI Number: | 1003276064 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | AP08728 |
| Business Practice Address: | 200 La Rue France 201 Lafayette, LA - 705083104 |
| Business Phone Number: | 3372359355 |
| Business Fax Number: | |
| Mailing Address: | 405 Breaux Rd, LAFAYETTE |
| State: | LA |
| Postal Code: | 705072596 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2016 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP08728 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |