Provider Demographics
NPI:1033702923
Name:KEEN, SARAH MITCHUM (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MITCHUM
Last Name:KEEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4106 ANTLER TRL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3900
Mailing Address - Country:US
Mailing Address - Phone:843-906-7920
Mailing Address - Fax:
Practice Address - Street 1:1770 DENNIS KEMP LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3938
Practice Address - Country:US
Practice Address - Phone:770-515-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287822163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse