Provider Demographics
NPI:1730794892
Name:KEEHN, JULIE MARIE (AGNP-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:KEEHN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:NISSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:141 S PURCELL BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5123
Mailing Address - Country:US
Mailing Address - Phone:719-281-9587
Mailing Address - Fax:
Practice Address - Street 1:141 S PURCELL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5123
Practice Address - Country:US
Practice Address - Phone:719-281-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995857-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health