Healthcare Provider Details

I. General information

NPI: 1447739859
Provider Name (Legal Business Name): RYAN PATRICK KEENAN DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEYMOUR ST STE 100
HARTFORD CT
06106-5521
US

IV. Provider business mailing address

74 BATTERSON PARK RD STE 107
FARMINGTON CT
06032-2565
US

V. Phone/Fax

Practice location:
  • Phone: 860-549-8276
  • Fax: 860-247-3803
Mailing address:
  • Phone: 860-549-8276
  • Fax: 860-244-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7670
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7670
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: