MEDICARE: MRS. AMBER KEENAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	226851	AZ

General Provider Information

NPI Number	:	1114644218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER KEENAN APRN

Provider Business Mailing Address
First Line	:	2228 W MICHELLE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1224
Country	:	US
Telephone Number	:	972-523-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 W MICHELLE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1224
Country	:	US
Telephone Number	:	972-523-6090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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