NPI | 1427719657 |
---|---|
Former Name | SHANNON MALLORY KEEGAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11016157) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11016157) |
Enumeration Date | 2022-01-10 |
Last Update Date | 2025-07-23 |