Healthcare Provider Details

I. General information

NPI: 1073135430
Provider Name (Legal Business Name): OLIVIA ANN KEENAN DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 WOODSTONE LN
LENEXA KS
66217-9622
US

IV. Provider business mailing address

7825 WOODSTONE LN
LENEXA KS
66217-9622
US

V. Phone/Fax

Practice location:
  • Phone: 785-640-8818
  • Fax:
Mailing address:
  • Phone: 785-640-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-78921-052
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number13-111822-052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: