Provider Demographics
NPI:1265590491
Name:KEEN, RONALD S (FNP-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:S
Last Name:KEEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 MUDRY CT
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3448
Mailing Address - Country:US
Mailing Address - Phone:337-531-3148
Mailing Address - Fax:337-531-3152
Practice Address - Street 1:5623 MUDRY CT
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-3448
Practice Address - Country:US
Practice Address - Phone:337-531-3148
Practice Address - Fax:337-531-3152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 099980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily