Provider Demographics
NPI:1164755112
Name:KEOGH, SALLY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:LYNN
Last Name:KEOGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 ROGERS LN
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4324
Mailing Address - Country:US
Mailing Address - Phone:678-451-8626
Mailing Address - Fax:
Practice Address - Street 1:3000 41ST ST OCEAN
Practice Address - Street 2:GUIDANCE CLINIC OF THE MIDDLE KEYS
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050
Practice Address - Country:US
Practice Address - Phone:305-434-9000
Practice Address - Fax:305-434-9041
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5150334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse