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Individual
KARISSA DEANN KEENAN
Active
Individual
KARISSA DEANN KEENAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
10100582-1205
UT
207V00000X
Obstetrics & Gynecology Physician
10100582-8905
UT
207V00000X
Obstetrics & Gynecology Physician
Primary
M-14675
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10100582-1205
UTAH LICENSE
UT
01
—
10100582-8905
UTAH CS SCHEDULE
UT
Enumeration date
04/08/2015
Last updated
07/26/2019
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