MEDICARE: EMILY T KEENAN CRNP-F

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	363LF0000X	Family Nurse Practitioner	0024168786	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C0410037	OTHER	DC	CAREFIRST OF DC
3	88225501	OTHER	MD	CAREFIRST OF MARYLAND

General Provider Information

NPI Number	:	1154476612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY T KEENAN CRNP-F

Provider Business Mailing Address
First Line	:	11713 WOLF RUN LN
Second Line	:
City	:	CLIFTON
State	:	VA
Zip	:	20124-2222
Country	:	US
Telephone Number	:	703-830-7926
Fax Number	:

Provider Business Practice Location Address
First Line	:	2281 VALLEY AVE
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2755
Country	:	US
Telephone Number	:	703-229-5453
Fax Number	:	888-352-8653

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/26/2024

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