Provider Demographics
NPI:1710471537
Name:KEENEY, TESSA J (PA-C)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:J
Last Name:KEENEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:NE
Mailing Address - Zip Code:68825-0100
Mailing Address - Country:US
Mailing Address - Phone:308-836-2294
Mailing Address - Fax:
Practice Address - Street 1:211 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825
Practice Address - Country:US
Practice Address - Phone:308-836-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant