Healthcare Provider Details

I. General information

NPI: 1326862137
Provider Name (Legal Business Name): MCKAYLA MILDRED KEEVEN DNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

5121 BARTER ST
SAINT CHARLES MO
63301-7415
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6000
  • Fax:
Mailing address:
  • Phone: 314-914-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2024043026
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2024043026
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: