Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 16632 | TN |
NPI | 1003182239 |
---|---|
Provider Name | Mrs. Maggie Elline Keck |
First Address | Seymour, TN 37865-4691 |
Second Address | Maryville, TN 37804-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 26/12/2018 |