Provider Demographics
NPI:1306195805
Name:KEATING, KATHLEEN M (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:KEATING
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:NETWORKS INC.
Mailing Address - Street 2:149 CHERRY ST
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-863-2495
Mailing Address - Fax:802-865-0534
Practice Address - Street 1:149 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3817
Practice Address - Country:US
Practice Address - Phone:802-863-2495
Practice Address - Fax:802-865-0534
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0089676363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health