Provider Demographics
NPI:1093786576
Name:KEEGAN, ROBERTA JAN (ARNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JAN
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:ARNP, FNP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-491-5681
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-5681
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0021928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048484OtherCIGNA BEHAVIORAL HEALTH
OK100128890AMedicaid
OK100128890AMedicaid