Healthcare Provider Details

I. General information

NPI: 1619626744
Provider Name (Legal Business Name): GINA LOUISE KEEDY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 E BROWN RD
MESA AZ
85205-4452
US

IV. Provider business mailing address

21168 E OCOTILLO RD # 1190
QUEEN CREEK AZ
85142-8175
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number270200
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270200
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: