Basic Information
| Provider Information | |||||||||
| NPI: | 1609915974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEEN | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | HARMON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 L V STABLER DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360373865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343829760 | ||||||||
| FaxNumber: | 3343839331 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 L V STABLER DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360373865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343829760 | ||||||||
| FaxNumber: | 3343839331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 10/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 1065300 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 128423 | 05 | AL | MEDICAID | 541003905 | 05 | AL | MEDICAID | 051077467 | 01 | AL | BC PROVIDER NO | OTHER |