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General NPI Number Information
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NPI Number | 1871871525
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Entity Type | Individual
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Provider Name | MARK DAVID KEESLING FNP
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 3647 J DEWEY GRAY CIR STE 200
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City | AUGUSTA
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State | GA
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Zip | 30909-2205
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Country | US
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Telephone | 706-504-9712
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Fax | 706-504-9703
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Provider Business Mailing Address
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Address Line | 811 13TH ST STE 20
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City | AUGUSTA
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State | GA
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Zip | 30901-2771
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Country | US
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Telephone | 706-722-3401
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Fax | 706-724-6540
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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 | RN193399
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.17582RX
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN193399
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License Number State | GA
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