Provider Demographics
NPI:1023449139
Name:KEEL, TAMMY LENN (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LENN
Last Name:KEEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LENN
Other - Last Name:GRIFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12717 MISSOURI BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1519
Mailing Address - Country:US
Mailing Address - Phone:636-498-1593
Mailing Address - Fax:
Practice Address - Street 1:12717 MISSOURI BOTTOM RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1519
Practice Address - Country:US
Practice Address - Phone:636-498-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006020219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse