Healthcare Provider Details

I. General information

NPI: 1780150201
Provider Name (Legal Business Name): SHANNON M KEANE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 11/28/2022
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 S ROBB WAY
LITTLETON CO
80127-4736
US

IV. Provider business mailing address

6131 S ROBB WAY
LITTLETON CO
80127-4736
US

V. Phone/Fax

Practice location:
  • Phone: 314-724-9505
  • Fax:
Mailing address:
  • Phone: 314-724-9505
  • Fax: 303-474-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0994066
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07181080
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0994066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: