Provider Demographics
NPI:1740940162
Name:KEENE, BROOKLYN (NP)
Entity type:Individual
Prefix:MRS
First Name:BROOKLYN
Middle Name:
Last Name:KEENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6852 ARBOREAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8128
Mailing Address - Country:US
Mailing Address - Phone:817-915-8018
Mailing Address - Fax:
Practice Address - Street 1:4231 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2691
Practice Address - Country:US
Practice Address - Phone:214-217-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046641208000000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatrics