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General NPI Number Information
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NPI Number | 1427130541
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Entity Type | Individual
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Provider Name | KELLIE M KEENAN P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 234 MALL BLVD STE G30
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2921
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Country | US
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Telephone | 800-321-9999
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Fax | 267-479-1321
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST STE 520
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4430
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Country | US
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Telephone | 800-321-9999
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Fax | 267-479-1321
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA052712
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License Number State | PA
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