Provider Demographics
NPI:1245731553
Name:WOMACK, KEEWANNA (FNP)
Entity type:Individual
Prefix:MRS
First Name:KEEWANNA
Middle Name:
Last Name:WOMACK
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 1:5151 PLANK RD STE 38
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-3501
Mailing Address - Country:US
Mailing Address - Phone:225-356-2006
Mailing Address - Fax:
Practice Address - Street 1:5151 PLANK RD STE 38
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-3501
Practice Address - Country:US
Practice Address - Phone:225-356-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner