1851040760 NPI number — MRS. KARI ELISE KEENE LDO, ABOC, NCLEC

Table of content: MRS. KARI ELISE KEENE LDO, ABOC, NCLEC (NPI 1851040760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851040760 NPI number — MRS. KARI ELISE KEENE LDO, ABOC, NCLEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEENE
Provider First Name:
KARI
Provider Middle Name:
ELISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LDO, ABOC, NCLEC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFFMEYER
Provider Other First Name:
KARI
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LDO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851040760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 ROBIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29730-7631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-984-1757
Provider Business Mailing Address Fax Number:
803-902-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 ROBIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730-7631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-984-1757
Provider Business Practice Location Address Fax Number:
803-902-2033
Provider Enumeration Date:
03/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FC0800X , with the licence number:  545 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: 1088 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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