Individual provider Active NPI

Grace Cline Keeven, FNP-C

  • Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1891270567
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2017024368 Issued in MO
Practice address
3635 Vista Ave
Saint Louis, MO 63110-2539
Phone
(314) 577-8000
NPI assigned
Sep 28, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2012021937 MO
Nurse Practitioner 363L00000X 2017024368 MO Primary

Addresses

Primary practice location

3635 Vista Ave
Saint Louis, MO 63110-2539

Mailing address

846 Berick Dr
Saint Louis, MO 63132-4809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190410000879 MO Practitioner - Nurse Practitioner 9335480805 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012021937MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
SLH Physicians LLC CurrentSince Mar 3, 2019 Accepting new patients

Locations

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

Interoperability endpoints

  • Direct secure messaging: gkeeven239062@direct-ehr-ssmhc.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1891270567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "846 BERICK DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631324809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEVEN",
        "first_name": "GRACE",
        "middle_name": "CLINE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2012021937",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2017024368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.