Individual
MS. DIANNA LAVEE KEELING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
233 S MAIN ST, LICKING, MO 65542-9325
(573) 674-3011
(573) 674-4765
Mailing address
PO BOX 47, LICKING, MO 65542-0047
(573) 674-3011
(573) 674-4765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2013002123
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609115237
—
MO
01
—
26D0679044
CLIA
MO
05
—
420002899
—
MO
01
—
431560263
TRICARE
MO
01
—
P01235241
RR MCR
MO
Enumeration date
02/01/2013
Last updated
12/30/2020
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