Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MA060729 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MA060729 | PA |
NPI | 1215589056 |
---|---|
Provider Name | Taylor Ann Keen |
First Address | Carlisle, PA 17013-8108 |
Second Address | Carlisle, PA 17013-3820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 19/11/2019 |