Provider Demographics
NPI:1245263805
Name:CHUNG, KEENA JOY ENNIS (CFNP, CPNP-AC)
Entity type:Individual
Prefix:MS
First Name:KEENA
Middle Name:JOY ENNIS
Last Name:CHUNG
Suffix:
Gender:F
Credentials:CFNP, CPNP-AC
Other - Prefix:
Other - First Name:KEENA
Other - Middle Name:JOY
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4900 MUELLER BLVD
Mailing Address - Street 2:DELL CHILDREN'S MEDICAL CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-324-0000
Mailing Address - Fax:512-324-0721
Practice Address - Street 1:4900 MUELLER BLVD
Practice Address - Street 2:DELL CHILDREN'S MEDICAL CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3079
Practice Address - Country:US
Practice Address - Phone:512-324-0000
Practice Address - Fax:512-324-0721
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741808363LA2100X
TXAP115959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741808OtherLICENSE NUMBER
TX7770OtherPRESCRIPTIVE AUTHORITY
TXY0195445OtherDPS
TXY0195445OtherDPS