Provider Demographics
NPI:1528505229
Name:KECK, DANIEL (FNP, NP-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:KECK
Suffix:
Gender:M
Credentials:FNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 SW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:KS
Mailing Address - Zip Code:66546-9662
Mailing Address - Country:US
Mailing Address - Phone:785-817-3944
Mailing Address - Fax:
Practice Address - Street 1:5823 SW 85TH ST
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:KS
Practice Address - Zip Code:66546-9662
Practice Address - Country:US
Practice Address - Phone:785-817-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377517122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily