Provider Demographics
NPI:1538304837
Name:KEEN, MARIAN JEANETTE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:JEANETTE
Last Name:KEEN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:JEANETTE
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:22 SHIPWASH DRIVE
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-662-7600
Mailing Address - Fax:919-662-7675
Practice Address - Street 1:22 SHIPWASH DRIVE
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-662-7600
Practice Address - Fax:919-662-7675
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001664363A00000X
WV2420363A00000X
NC0010-01664363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical