Provider Demographics
NPI:1831210392
Name:RISOLA, KEENA COLLEEN (DO)
Entity type:Individual
Prefix:DR
First Name:KEENA
Middle Name:COLLEEN
Last Name:RISOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3764 MANHATTAN CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5441
Mailing Address - Country:US
Mailing Address - Phone:850-776-2837
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST STE 208
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6336
Practice Address - Country:US
Practice Address - Phone:850-438-1136
Practice Address - Fax:850-438-1148
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010160502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology