Provider Demographics
NPI:1194581199
Name:MANNING, KEANNA R
Entity type:Individual
Prefix:
First Name:KEANNA
Middle Name:R
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9837 COOLIDGE AVE # A
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1404
Mailing Address - Country:US
Mailing Address - Phone:804-637-8398
Mailing Address - Fax:
Practice Address - Street 1:2300 OLD SPANISH TRL APT 2067
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2172
Practice Address - Country:US
Practice Address - Phone:804-637-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3845152374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula