Provider Demographics
NPI:1336649276
Name:KEINER, ALYSSA S (AGNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:S
Last Name:KEINER
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SPRINGMILL DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3013
Mailing Address - Country:US
Mailing Address - Phone:636-751-3405
Mailing Address - Fax:
Practice Address - Street 1:1620 SPRINGMILL DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3013
Practice Address - Country:US
Practice Address - Phone:636-751-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001324363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health