Provider Demographics
NPI:1083314298
Name:KEEN HEALTH & WELLNESS SERVICES PLLC
Entity Type:Organization
Organization Name:KEEN HEALTH & WELLNESS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEANDRA
Authorized Official - Middle Name:LANAE
Authorized Official - Last Name:THOMPOSN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ARNP
Authorized Official - Phone:360-649-4030
Mailing Address - Street 1:446 NE INSPIRATION ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-4512
Mailing Address - Country:US
Mailing Address - Phone:360-551-5138
Mailing Address - Fax:
Practice Address - Street 1:2801 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2443
Practice Address - Country:US
Practice Address - Phone:360-649-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2203211Medicaid