Provider Demographics
NPI:1851998462
Name:KEENEY, GREG E
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:E
Last Name:KEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PENNSYLVANIA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2259
Mailing Address - Country:US
Mailing Address - Phone:817-332-6397
Mailing Address - Fax:817-332-5513
Practice Address - Street 1:1015 PENNSYLVANIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2259
Practice Address - Country:US
Practice Address - Phone:817-332-6397
Practice Address - Fax:817-332-5513
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50439237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist