Healthcare Provider Details

I. General information

NPI: 1932460508
Provider Name (Legal Business Name): LISA MARIE KEELING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 E LAYFAIR DR
FLOWOOD MS
39232-9526
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-6520
  • Fax:
Mailing address:
  • Phone: 601-414-6520
  • Fax: 601-414-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24643
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24643
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: