Healthcare Provider Details

I. General information

NPI: 1184551749
Provider Name (Legal Business Name): JOSLYN KEENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 10TH ST STE B
GREAT BEND KS
67530-3497
US

IV. Provider business mailing address

4107 10TH ST STE B
GREAT BEND KS
67530-3497
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5944
  • Fax:
Mailing address:
  • Phone: 620-792-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-100500
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: