Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 9350771 | FL |
NPI | 1083967434 |
---|---|
Provider Name | Ms. Kelly Kay Keener |
First Address | Bradenton, FL 34205-8809 |
Second Address | St Petersburg, FL 33701-4630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 23/10/2012 |