MEDICARE: CAROL R. KEENHOLTS A.R.N.P.

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	AP30001206	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346263472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL R. KEENHOLTS A.R.N.P.

Provider Business Mailing Address
First Line	:	200 W MERCER ST
Second Line	:	#104
City	:	SEATTLE
State	:	WA
Zip	:	98119-3995
Country	:	US
Telephone Number	:	206-281-7163
Fax Number	:	206-281-5088

Provider Business Practice Location Address
First Line	:	200 W MERCER ST
Second Line	:	#104
City	:	SEATTLE
State	:	WA
Zip	:	98119-3995
Country	:	US
Telephone Number	:	206-281-7163
Fax Number	:	206-281-5088

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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