Healthcare Provider Details

I. General information

NPI: 1588661912
Provider Name (Legal Business Name): NANCY J. KEELEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLACK OAK DR SUITE 100
MEDFORD OR
97504-8447
US

IV. Provider business mailing address

PO BOX 1803
MEDFORD OR
97501-0262
US

V. Phone/Fax

Practice location:
  • Phone: 541-734-3430
  • Fax: 541-732-3980
Mailing address:
  • Phone: 541-734-3430
  • Fax: 541-732-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: