Provider Demographics
NPI:1447063839
Name:KEENAN, KILEY (RDN)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BROOKLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3804
Mailing Address - Country:US
Mailing Address - Phone:610-393-6880
Mailing Address - Fax:
Practice Address - Street 1:112 BROOKLINE BLVD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3804
Practice Address - Country:US
Practice Address - Phone:610-393-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered