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NPI Code Detail

MEDICARE: RYAN KEEN

MEDICARE: RYAN KEEN
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
1363A00000XPhysician AssistantPA65829CA

General Provider Information

NPI Number : 1710762588
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN KEEN
Provider Business Mailing Address
First Line : 1462 CLIFTON RD NE STE 280
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1063
Country : US
Telephone Number : 404-727-7825
Fax Number :
Provider Business Practice Location Address
First Line : 201 E LAKEVIEW AVE
Second Line :
City : WOODLAKE
State : CA
Zip : 93286-1301
Country : US
Telephone Number : 877-960-3426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2023
Last Update Date : 04/29/2025

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Directions to “ RYAN KEEN ” Practice Location

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