Provider Demographics
NPI:1770190530
Name:KEECH, KIMBERLY (FNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KEECH
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4612
Mailing Address - Country:US
Mailing Address - Phone:407-767-0009
Mailing Address - Fax:
Practice Address - Street 1:460 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4612
Practice Address - Country:US
Practice Address - Phone:407-767-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11008652OtherDEPARTMENT OF HEALTH