Provider Demographics
NPI:1083707319
Name:KEAGY, ANDREA DOORACK (FNP , RN, PHN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DOORACK
Last Name:KEAGY
Suffix:
Gender:F
Credentials:FNP , RN, PHN
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Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:3885 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3840
Practice Address - Country:US
Practice Address - Phone:415-529-4522
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA632547163W00000X
CA15545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse