Healthcare Provider Details

I. General information

NPI: 1972436061
Provider Name (Legal Business Name): AMANDA DAWN KEEVEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SWORD LILY DR
O FALLON MO
63366-7593
US

IV. Provider business mailing address

204 SWORD LILY DR
O FALLON MO
63366-7593
US

V. Phone/Fax

Practice location:
  • Phone: 800-485-9002
  • Fax:
Mailing address:
  • Phone: 800-485-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2020021011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: