Healthcare Provider Details

I. General information

NPI: 1083757884
Provider Name (Legal Business Name): STEPHEN ROBERT KEENER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BILLINGSLEY RD
CHARLOTTE NC
28211-1003
US

IV. Provider business mailing address

4617 COLONY RD APT I
CHARLOTTE NC
28226-4984
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-4705
  • Fax: 704-336-4709
Mailing address:
  • Phone: 704-551-0715
  • Fax: 704-336-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28053
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number28053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: