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General NPI Number Information
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NPI Number | 1003553520
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Entity Type | Individual
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Provider Name | RICHARD ALBERT KEENAN JR. FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1500 W POPLAR AVE STE 206
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0601
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Country | US
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Telephone | 901-861-8484
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Fax | 901-861-8489
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Provider Business Mailing Address
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Address Line | 428 NUTHATCH DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1069
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Country | US
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Telephone | 901-830-1959
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Fax | 901-767-8302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 31700
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License Number State | TN
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