Individual
STEPHANIE RENEE KEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4318 TRAIL BOSS DR, STE 100, CASTLE ROCK, CO 80104-7512
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2163
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025615
KAISER COMMERCIAL NUMBER
CO
05
—
37279513
—
CO
Enumeration date
10/02/2006
Last updated
06/18/2021
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