Provider Demographics
NPI:1619606647
Name:KEENAN, MATTHEW (RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KEENAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7616
Mailing Address - Country:US
Mailing Address - Phone:501-802-4604
Mailing Address - Fax:
Practice Address - Street 1:4229 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-7616
Practice Address - Country:US
Practice Address - Phone:501-802-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse