Provider Demographics
NPI:1700223609
Name:STATEN, KEENYA ANDERSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KEENYA
Middle Name:ANDERSON
Last Name:STATEN
Suffix:
Gender:F
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 1:1701 SUNSET AVE STE 105C
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4344
Mailing Address - Country:US
Mailing Address - Phone:252-969-0432
Mailing Address - Fax:888-977-1275
Practice Address - Street 1:1701 SUNSET AVE STE 105C
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-969-0432
Practice Address - Fax:888-977-1275
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006213363LP0808X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care