Healthcare Provider Details

I. General information

NPI: 1134918550
Provider Name (Legal Business Name): SERENE MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W 78TH STREET CIR STE 265
BLOOMINGTON MN
55435-5408
US

IV. Provider business mailing address

4470 W 78TH STREET CIR STE 265
BLOOMINGTON MN
55435-5408
US

V. Phone/Fax

Practice location:
  • Phone: 952-260-3367
  • Fax: 952-213-4260
Mailing address:
  • Phone: 952-260-3367
  • Fax: 952-213-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FARTUN AHMED KEYNAN
Title or Position: NURSE PRACTITIONER
Credential: APRN, FNP, PMHNP
Phone: 952-260-3367