Healthcare Provider Details

I. General information

NPI: 1649868357
Provider Name (Legal Business Name): BRITIANI KEEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 MCDOWELL ROAD EXT
JACKSON MS
39204-4238
US

IV. Provider business mailing address

2860 MCDOWELL ROAD EXT
JACKSON MS
39204-4238
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-1117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904248
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: