Provider Demographics
NPI:1396984795
Name:KEENMON, CORINNA (MD)
Entity type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:
Last Name:KEENMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST STE 961
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2722
Mailing Address - Country:US
Mailing Address - Phone:713-795-4441
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 961
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2722
Practice Address - Country:US
Practice Address - Phone:713-795-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1169572084P0800X
TX443102084P0805X
TXP74802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA116957OtherTHE MEDICAL BOARD OF CALIFORNIA
TXBP10028757OtherTEXAS MEDICAL BOARD
TXP7480OtherTEXAS MEDICAL BOARD
CAA116957OtherTHE MEDICAL BOARD OF CALIFORNIA