Provider Demographics
NPI:1689124414
Name:KEEN, MATTHEW (FNP-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KEEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 LAFAYETTE CTR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3943
Mailing Address - Country:US
Mailing Address - Phone:636-707-0764
Mailing Address - Fax:636-707-0520
Practice Address - Street 1:409 LAFAYETTE CTR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-3943
Practice Address - Country:US
Practice Address - Phone:636-707-0764
Practice Address - Fax:636-707-0520
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily