Healthcare Provider Details

I. General information

NPI: 1629058433
Provider Name (Legal Business Name): MARION MONIQUE KEELING RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2398
US

IV. Provider business mailing address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2398
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4011
  • Fax:
Mailing address:
  • Phone: 919-956-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164233
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011849
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: