MEDICARE: DR. MENGESHA KEELEN DNP

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	363LG0600X	Gerontology Nurse Practitioner	5021870	NC
2	363LP2300X	Primary Care Nurse Practitioner	5021870	NC

General Provider Information

NPI Number	:	1942915939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MENGESHA KEELEN DNP

Provider Business Mailing Address
First Line	:	PO BOX 8528
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1528
Country	:	US
Telephone Number	:	504-782-3047
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 WALBROOK CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8404
Country	:	US
Telephone Number	:	504-782-3047
Fax Number	:

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

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	12/11/2025

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