Keenan Garrett, MD
Individual provider Active NPI Internal Medicine Physician · North Las Vegas, NV
NPI 1104313063 · NPPES record last updated Apr 20, 2022
Key facts
- NPI
- 1104313063
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 21196 (NV)
- Practice address
- 6900 N Pecos Rd
North Las Vegas, NV 89086-4400 - Phone
- (702) 791-9000
- NPI assigned
- Apr 17, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180822000063 | NV | Order and Referring Only - Internal Medicine |
8325397532 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21196 | NV | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unlv Medicine | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 21196 | NV | Yes |
Addresses
Primary practice location
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Mailing address
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Other providers in North Las Vegas, NV
- Garner Enterprises
- Debra Garner
- Nick Edward Garness I
- Gina Garofalo
- Jesse O Garrett
- Alexander D Garza
- Brezhae Gasaway
- Elizabeth Gasca
- Latina Gaston
- Latonya Reashawn Gaston
All providers in North Las Vegas, NV · Internal Medicine Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.