Provider Demographics
NPI:1003553520
Name:KEENAN, RICHARD ALBERT JR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALBERT
Last Name:KEENAN
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 NUTHATCH DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1069
Mailing Address - Country:US
Mailing Address - Phone:901-830-1959
Mailing Address - Fax:901-767-8302
Practice Address - Street 1:1500 W POPLAR AVE STE 206
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0601
Practice Address - Country:US
Practice Address - Phone:901-861-8484
Practice Address - Fax:901-861-8489
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily