Healthcare Provider Details

I. General information

NPI: 1942822630
Provider Name (Legal Business Name): CARLY KEENAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 251
WEST BURLINGTON IA
52655-1688
US

IV. Provider business mailing address

1225 S GEAR AVE STE 251
WEST BURLINGTON IA
52655-1688
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-1000
  • Fax:
Mailing address:
  • Phone: 319-768-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO-06671
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: