Provider Demographics
NPI:1518619402
Name:KEEGAN, KATHRYN M (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ANNA RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-1104
Mailing Address - Country:US
Mailing Address - Phone:781-413-5190
Mailing Address - Fax:
Practice Address - Street 1:43 ANNA RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-1104
Practice Address - Country:US
Practice Address - Phone:781-413-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN216269163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant