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NPI Code Detail

MEDICARE: PHYLLIS KEENER N.P.

MEDICARE: PHYLLIS KEENER 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
1363LX0001XObstetrics & Gynecology Nurse Practitioner199776CA

General Provider Information

NPI Number : 1538195045
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS KEENER N.P.
Provider Business Mailing Address
First Line : 1000 W CARSON ST
Second Line : N-25, #471
City : TORRANCE
State : CA
Zip : 90502-2004
Country : US
Telephone Number : 310-222-3382
Fax Number : 310-222-2882
Provider Business Practice Location Address
First Line : 1333 CHESTNUT AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-2944
Country : US
Telephone Number : 562-599-8601
Fax Number : 562-218-0853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/08/2007

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