Provider Demographics
NPI:1437112216
Name:KEOWN, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:KEOWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-329-3595
Mailing Address - Fax:615-327-4934
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-329-3595
Practice Address - Fax:615-327-4934
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3020904Medicaid
TN17020OtherMD
TN3020904Medicaid