=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093520280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEEGAN WHITELEY CPNP-AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 FLOYD CURL DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-575-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28815 THROSSEL LN
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78260-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-364-5315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1190929
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0222X
-----------------------------------------------------
Taxonomy Name | Critical Care Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 1190929
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------