Individual
KEENA ROSE OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2139 8TH ST, CLARKSDALE, MS 38614-6207
(901) 649-1123
Mailing address
146 COUNTY ROAD 269, WOODLAND, MS 39776-9617
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
902274
MS
163WC1500X
Community Health Registered Nurse
902274
MS
Other
Enumeration date
06/22/2018
Last updated
06/22/2018
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