Provider Demographics
NPI:1760240337
Name:AWWAD, KEELEY GRACE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KEELEY
Middle Name:GRACE
Last Name:AWWAD
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 1:84 COUNTY ROAD 5211
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-9422
Mailing Address - Country:US
Mailing Address - Phone:662-416-6282
Mailing Address - Fax:
Practice Address - Street 1:1710 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1216
Practice Address - Country:US
Practice Address - Phone:662-840-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily