Individual
KEEGAN EISENHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6405 S VILLA AVE, OKLAHOMA CITY, OK 73159-2741
(405) 905-0285
Mailing address
6405 S VILLA AVE, OKLAHOMA CITY, OK 73159-2741
(405) 905-0285
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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