MEDICARE: MR. RONALD S. KEEN FNP-C

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	363LF0000X	Family Nurse Practitioner	RN 099980	AZ

General Provider Information

NPI Number	:	1265590491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD S. KEEN FNP-C

Provider Business Mailing Address
First Line	:	5623 MUDRY CT
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-3448
Country	:	US
Telephone Number	:	337-531-3148
Fax Number	:	337-531-3152

Provider Business Practice Location Address
First Line	:	5623 MUDRY CT
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-3448
Country	:	US
Telephone Number	:	337-531-3148
Fax Number	:	337-531-3152

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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