Provider Demographics
NPI:1770968786
Name:KEENER, PANDA (NP)
Entity type:Individual
Prefix:
First Name:PANDA
Middle Name:
Last Name:KEENER
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:CIGNA ONSITE HEALTH LLC
Mailing Address - Street 2:25500 N NORTERRA DR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:
Practice Address - Street 1:3090 SUGAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:SUGAR VALLEY
Practice Address - State:GA
Practice Address - Zip Code:30746
Practice Address - Country:US
Practice Address - Phone:706-624-4661
Practice Address - Fax:706-624-4698
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily