Healthcare Provider Details

I. General information

NPI: 1972759231
Provider Name (Legal Business Name): RONDA LYNN KEENEY PMHCNS-BX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

215 CORTNER DRIVE
SMITHTON IL
62285
US

V. Phone/Fax

Practice location:
  • Phone: 131-465-2410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2005010545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: