Provider Demographics
NPI:1609358415
Name:HUNTER, KEANNA (APRN)
Entity Type:Individual
Prefix:
First Name:KEANNA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 JACK BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 EMMETT F LOWRY EXPY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2500
Practice Address - Country:US
Practice Address - Phone:409-440-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-12-07
Deactivation Date:2021-01-25
Deactivation Code:
Reactivation Date:2022-09-28
Provider Licenses
StateLicense IDTaxonomies
TX1088697363LF0000X
TX947402163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX851316605Medicaid