Provider Demographics
NPI:1972022465
Name:KEENAN, AMBER ROSE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ROSE
Last Name:KEENAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SUNBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:510-676-9211
Mailing Address - Fax:
Practice Address - Street 1:1100 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6446
Practice Address - Country:US
Practice Address - Phone:707-258-8100
Practice Address - Fax:707-258-0734
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner