Provider Demographics
NPI:1376046177
Name:KECKEIS, CAITLIN (APRN)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:KECKEIS
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 1:7777 YANKEE RD # MLC16078
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3500
Mailing Address - Country:US
Mailing Address - Phone:513-636-8790
Mailing Address - Fax:513-803-8406
Practice Address - Street 1:7777 YANKEE RD # MLC16078
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:513-636-8790
Practice Address - Fax:513-803-8406
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022263363L00000X
OHRN.385891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse