MEDICARE: MEGAN BLACKWELDER KEENER NP

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	24142	SC

General Provider Information

NPI Number	:	1316607583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN BLACKWELDER KEENER NP

Provider Business Mailing Address
First Line	:	1711 CRICKET RUN
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-8937
Country	:	US
Telephone Number	:	803-325-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 EDGEWATER CORPORATE PKWY
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-4514
Country	:	US
Telephone Number	:	803-547-8660
Fax Number	:	803-650-3880

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

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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