Healthcare Provider Details

I. General information

NPI: 1538195045
Provider Name (Legal Business Name): PHYLLIS KEENER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CHESTNUT AVE
LONG BEACH CA
90813-2944
US

IV. Provider business mailing address

1000 W CARSON ST N-25, #471
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-8601
  • Fax: 562-218-0853
Mailing address:
  • Phone: 310-222-3382
  • Fax: 310-222-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number199776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: