Healthcare Provider Details

I. General information

NPI: 1942915939
Provider Name (Legal Business Name): MENGESHA KEELEN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WALBROOK CT
ROCKY MOUNT NC
27804-8404
US

IV. Provider business mailing address

PO BOX 8528
ROCKY MOUNT NC
27804-1528
US

V. Phone/Fax

Practice location:
  • Phone: 504-782-3047
  • Fax:
Mailing address:
  • Phone: 504-782-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5021870
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5021870
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: