Provider Demographics
NPI:1770398737
Name:KEEN, ANGELICIA (LPN)
Entity type:Individual
Prefix:
First Name:ANGELICIA
Middle Name:
Last Name:KEEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ANGELICIA
Other - Middle Name:
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6915 SOCKEYE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-3569
Mailing Address - Country:US
Mailing Address - Phone:256-328-3235
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN STE 106
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK229209164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse