Provider Demographics
NPI:1396042404
Name:KEIGHER, KIFFON M (NP)
Entity Type:Individual
Prefix:
First Name:KIFFON
Middle Name:M
Last Name:KEIGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 970
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-6644
Mailing Address - Fax:312-942-2176
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 970
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-6644
Practice Address - Fax:312-942-2176
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-008120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner