Individual
MARY KATHRYN KEENAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3701 LAFAYETTE RD, EVANSDALE, IA 50707-1129
(319) 274-7060
Mailing address
3701 LAFAYETTE RD, EVANSDALE, IA 50707-1129
(319) 274-7060
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002249
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356613012
—
IA
01
—
P01146291 GRP CC6519
RR MEDICARE
IA
Enumeration date
01/27/2012
Last updated
01/03/2017
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