Provider Demographics
NPI:1356016166
Name:KEESEY, MEGAN S (APNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:S
Last Name:KEESEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:S
Other - Last Name:LEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 CORBIN DR
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9432
Mailing Address - Country:US
Mailing Address - Phone:608-574-7036
Mailing Address - Fax:
Practice Address - Street 1:103 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507-9408
Practice Address - Country:US
Practice Address - Phone:608-924-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10453-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily