Provider Demographics
NPI:1033735378
Name:KEAVENEY, CARMEL M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARMEL
Middle Name:M
Last Name:KEAVENEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TEREGRAM PL
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2558
Mailing Address - Country:US
Mailing Address - Phone:401-855-5346
Mailing Address - Fax:
Practice Address - Street 1:3 TEREGRAM PL
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2558
Practice Address - Country:US
Practice Address - Phone:401-855-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner