Healthcare Provider Details

I. General information

NPI: 1023502606
Provider Name (Legal Business Name): PRIYA KEANE DNP, AG-ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR STE 111
ANCHORAGE AK
99508-4662
US

IV. Provider business mailing address

1002 W 15TH AVE
ANCHORAGE AK
99501-4942
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-7890
  • Fax:
Mailing address:
  • Phone: 918-260-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number159071
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number201392788RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: