Healthcare Provider Details

I. General information

NPI: 1528505229
Provider Name (Legal Business Name): DANIEL KECK FNP, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 SW 85TH ST
WAKARUSA KS
66546-9662
US

IV. Provider business mailing address

5823 SW 85TH ST
WAKARUSA KS
66546-9662
US

V. Phone/Fax

Practice location:
  • Phone: 785-817-3944
  • Fax:
Mailing address:
  • Phone: 785-817-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5377517122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: