Healthcare Provider Details

I. General information

NPI: 1255119087
Provider Name (Legal Business Name): FARTUN AHMED KEYNAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 UNIVERSITY AVE W
SAINT PAUL MN
55104-4807
US

IV. Provider business mailing address

425 20TH AVE S
MINNEAPOLIS MN
55454-4400
US

V. Phone/Fax

Practice location:
  • Phone: 651-665-9795
  • Fax: 651-665-9796
Mailing address:
  • Phone: 612-332-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9850
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2441926
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: