Provider Demographics
NPI:1225587926
Name:HASH, KEEGAN
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:HASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4177 SPICE MARKET N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2596
Mailing Address - Country:US
Mailing Address - Phone:614-549-0721
Mailing Address - Fax:
Practice Address - Street 1:4177 SPICE MARKET N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2596
Practice Address - Country:US
Practice Address - Phone:614-549-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN157768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse