Provider Demographics
NPI:1114437902
Name:KEESEE, TAMARA ASHLEY (FNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ASHLEY
Last Name:KEESEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:ASHLEY
Other - Last Name:LUNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5329
Practice Address - Fax:573-315-0853
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029631163WG0000X
MO2017016071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice