Provider Demographics
NPI:1073520896
Name:KEENEY, KIMBERLY K
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:KEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-0638
Mailing Address - Country:US
Mailing Address - Phone:573-323-8584
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST.
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-0486
Practice Address - Country:US
Practice Address - Phone:573-323-4253
Practice Address - Fax:573-323-4465
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide