Provider Demographics
NPI:1710672472
Name:KEEN, KIMBERLY D (CPS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:KEEN
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 KENNETH LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4930
Mailing Address - Country:US
Mailing Address - Phone:913-318-9797
Mailing Address - Fax:
Practice Address - Street 1:544 KENNETH LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4930
Practice Address - Country:US
Practice Address - Phone:913-318-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15868175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty