Provider Demographics
NPI:1023502606
Name:KEANE, PRIYA (DNP, AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:DNP, AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4942
Mailing Address - Country:US
Mailing Address - Phone:918-260-5698
Mailing Address - Fax:
Practice Address - Street 1:3200 PROVIDENCE DR STE 111
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4662
Practice Address - Country:US
Practice Address - Phone:907-212-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392788RN390200000X
AK159071363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program