Provider Demographics
NPI:1548797624
Name:KEEFE, REGINA KITTERMAN (APRN-PMH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:KITTERMAN
Last Name:KEEFE
Suffix:
Gender:F
Credentials:APRN-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 OLNEY SANDY SPRING RD STE C
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3507
Mailing Address - Country:US
Mailing Address - Phone:301-466-9457
Mailing Address - Fax:
Practice Address - Street 1:2911 OLNEY SANDY SPRING RD STE C
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3507
Practice Address - Country:US
Practice Address - Phone:301-466-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR115535364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult