Provider Demographics
NPI:1306468046
Name:KEYESKI, CONNER REID (APRN)
Entity type:Individual
Prefix:MR
First Name:CONNER
Middle Name:REID
Last Name:KEYESKI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 WESTDALE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2637
Mailing Address - Country:US
Mailing Address - Phone:785-760-0695
Mailing Address - Fax:
Practice Address - Street 1:1026 WESTDALE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2637
Practice Address - Country:US
Practice Address - Phone:785-760-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79422-021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner