Healthcare Provider Details

I. General information

NPI: 1295848992
Provider Name (Legal Business Name): SANDRA K KEENER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BROADWAY BLVD
KANSAS CITY MO
64111-2659
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-960-8000
  • Fax: 816-960-8046
Mailing address:
  • Phone: 816-701-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2016034419
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number505
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: