Provider Demographics
NPI:1609274083
Name:KEEGAN, KASSIE (CNP)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE # MLC2005
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4259
Mailing Address - Fax:513-636-4267
Practice Address - Street 1:3333 BURNET AVE # MLC2005
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4259
Practice Address - Fax:513-636-4267
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021240363LA2100X, 363L00000X
TXAP127077363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care