Provider Demographics
NPI:1457834590
Name:KEEN, ALEXIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:KEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487A WOODMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1629
Mailing Address - Country:US
Mailing Address - Phone:865-406-1301
Mailing Address - Fax:
Practice Address - Street 1:201 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2301
Practice Address - Country:US
Practice Address - Phone:615-859-7546
Practice Address - Fax:615-851-7760
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant