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General NPI Number Information
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NPI Number | 1972308880
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Entity Type | Individual
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Provider Name | KEENAN JOHARI HONORE
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Gender | Male
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 236 W 34TH AVE # 218
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City | ANCHORAGE
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State | AK
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Zip | 99503-3977
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Country | US
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Telephone | 907-290-5500
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Fax | 907-302-5990
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Provider Business Mailing Address
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Address Line | 236 W 34TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99503-3977
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Country | US
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Telephone | 907-290-5500
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Fax | 907-302-5990
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 225119
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License Number State | AK
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