Panda Keener, N.P.

Key facts

NPI

1770968786

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

RN222731 (GA)

Practice address

3090 Sugar Valley Rd
Sugar Valley, GA 30746

Phone

(706) 624-4661

Fax

(706) 624-4698

NPI assigned

Jul 21, 2015

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2017.

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513728000000",
    "number": "1770968786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CIGNA ONSITE HEALTH LLC",
            "address_2": "25500 N NORTERRA DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85085",
            "telephone_number": "623-277-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3090 SUGAR VALLEY RD",
            "city": "SUGAR VALLEY",
            "state": "GA",
            "postal_code": "30746",
            "telephone_number": "706-624-4661",
            "fax_number": "706-624-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENER",
        "first_name": "PANDA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-21",
        "last_updated": "2017-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN222731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Valley, GA

• Sarah Boswell, CPM
• Ethan Brown
• Amna Khan Handley, M.S.N, BSN, RN, CIC
• Phyllis Wrenn Sackariasen, PA-C
• Warren Roger Thomas, D.O.

All providers in Sugar Valley, GA · Family Nurse Practitioner in Georgia