Provider Demographics
NPI:1528532306
Name:KEELIN, MATTHEW JAMES (ARNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:KEELIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NW 189TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-5779
Mailing Address - Country:US
Mailing Address - Phone:360-887-2560
Mailing Address - Fax:
Practice Address - Street 1:6801 NE CORNFOOT RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2743
Practice Address - Country:US
Practice Address - Phone:503-249-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60919295363LF0000X
OR10004744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily