MEDICARE: KEANNA R MANNING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	3845152	TX

General Provider Information

NPI Number	:	1194581199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEANNA R MANNING

Provider Business Mailing Address
First Line	:	9837 COOLIDGE AVE # A
Second Line	:
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98433-1404
Country	:	US
Telephone Number	:	804-637-8398
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 OLD SPANISH TRL APT 2067
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2172
Country	:	US
Telephone Number	:	804-637-8398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “ KEANNA R MANNING ” Practice Location

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