Provider Demographics
NPI:1538746482
Name:KEASLING, DANIELLE DALYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DALYNN
Last Name:KEASLING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 W CAMINO PABLO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-4083
Mailing Address - Country:US
Mailing Address - Phone:719-423-9869
Mailing Address - Fax:
Practice Address - Street 1:1711 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3349
Practice Address - Country:US
Practice Address - Phone:719-543-8751
Practice Address - Fax:719-543-7496
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0996407-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily