Provider Demographics
NPI:1013248699
Name:KEENHOLD, AMANDA MICHELE (DNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELE
Last Name:KEENHOLD
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BOEHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3101 N CENTRAL AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2635
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:
Practice Address - Street 1:2204 S DOBSON RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:480-628-8577
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN187348163W00000X
AZ272626363LP0808X, 363LP0808X
AK8925164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse