Provider Demographics
NPI:1124890652
Name:KEOMANY, PHONEMALY OUTHICHAMPHONE (RN)
Entity type:Individual
Prefix:
First Name:PHONEMALY
Middle Name:OUTHICHAMPHONE
Last Name:KEOMANY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4910
Mailing Address - Country:US
Mailing Address - Phone:509-222-6203
Mailing Address - Fax:509-222-6201
Practice Address - Street 1:105 W 21ST AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-4910
Practice Address - Country:US
Practice Address - Phone:509-222-6203
Practice Address - Fax:509-222-6201
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60127551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse