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General NPI Number Information
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NPI Number | 1083314298
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Entity Type | Organization
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Legal Business Name | KEEN HEALTH & WELLNESS SERVICES PLLC
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 2801 S JACKSON ST
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City | SEATTLE
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State | WA
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Zip | 98144-2443
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Country | US
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Telephone | 360-649-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 446 NE INSPIRATION ST
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City | POULSBO
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State | WA
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Zip | 98370-4512
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Country | US
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Telephone | 360-551-5138
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. KEANDRA LANAE THOMPOSN
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Credential | DNP, ARNP
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Telephone | 360-649-4030
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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