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General NPI Number Information
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NPI Number | 1740019033
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Entity Type | Individual
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Provider Name | LYNNELLE CHRISTINE KEANE
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Gender | Female
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 360 E EH CRUMP BLVD
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City | MEMPHIS
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State | TN
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Zip | 38126-5310
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Country | US
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Telephone | 901-261-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 60000 HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0001
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Country | US
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Telephone |
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 10025
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License Number State | TN
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