Provider Demographics
NPI:1942915939
Name:KEELEN, MENGESHA
Entity Type:Individual
Prefix:
First Name:MENGESHA
Middle Name:
Last Name:KEELEN
Suffix:
Gender:F
Credentials:
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 8528
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1528
Mailing Address - Country:US
Mailing Address - Phone:504-782-3047
Mailing Address - Fax:
Practice Address - Street 1:90 WALBROOK CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8404
Practice Address - Country:US
Practice Address - Phone:504-782-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program