MEDICARE: ANGIE LYNN KEEGAN RD

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	133V00000X	Registered Dietitian	0776	SD
2	133V00000X	Registered Dietitian	01366	IA

General Provider Information

NPI Number	:	1356210363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE LYNN KEEGAN RD

Provider Business Mailing Address
First Line	:	9080 UNIVERSITY AVE
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1892
Country	:	US
Telephone Number	:	515-415-6232
Fax Number	:	515-264-2282

Provider Business Practice Location Address
First Line	:	9080 UNIVERSITY AVE
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1892
Country	:	US
Telephone Number	:	515-415-6232
Fax Number	:	515-264-2282

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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