Healthcare Provider Details

I. General information

NPI: 1588139562
Provider Name (Legal Business Name): HOLLY KEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 N RODNEY PARHAM RD STE A7
LITTLE ROCK AR
72212-4159
US

IV. Provider business mailing address

10700 N RODNEY PARHAM RD STE A7
LITTLE ROCK AR
72212-4159
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-6060
  • Fax: 501-225-6450
Mailing address:
  • Phone: 501-225-6060
  • Fax: 501-225-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number200343
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: