Provider Demographics
NPI:1609413251
Name:EAGAN, KEARA LEIGH (APN)
Entity Type:Individual
Prefix:
First Name:KEARA
Middle Name:LEIGH
Last Name:EAGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KEARA
Other - Middle Name:LEIGH
Other - Last Name:AHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 LAUREL OAK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3518
Mailing Address - Country:US
Mailing Address - Phone:856-783-1777
Mailing Address - Fax:856-783-8519
Practice Address - Street 1:1020 LAUREL OAK RD STE 102
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3518
Practice Address - Country:US
Practice Address - Phone:865-783-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00984200363LG0600X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology