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NPI Code Detail

MEDICARE: KRISTINE LIANA KEENE-HETH APRN-C

MEDICARE: KRISTINE LIANA KEENE-HETH APRN-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
1363L00000XNurse PractitionerAG03180101FL

Other Identifiers

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

General Provider Information

NPI Number : 1902383110
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE LIANA KEENE-HETH APRN-C
Provider Business Mailing Address
First Line : PO BOX 7410884
Second Line :
City : CHICAGO
State : IL
Zip : 60674-0884
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Provider Business Practice Location Address
First Line : 1818 E FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-3770
Country : US
Telephone Number : 872-231-3162
Fax Number : 313-635-0050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2018
Last Update Date : 10/02/2025

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