Doctor Name: | MARY SUE KEEN |
NPI Number: | 1275573883 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0024166335 |
Business Practice Address: | 6791 Gov. G. C. Peery Hwy Suite 3100 Richlands, VA - 246412099 |
Business Phone Number: | 2769649102 |
Business Fax Number: | 2769632865 |
Mailing Address: | P. O. Box 900, RICHLANDS |
State: | VA |
Postal Code: | 246229617 |
Phone Number: | 2769649102 |
Fax Number: | 2769632865 |
NPI Enumeration Date: | 06/08/2006 |
NPI Last Update Date: | 03/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024166335 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |