Provider Demographics
NPI:1629327622
Name:KEHOE, CELESTE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:KEHOE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:SHAMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 WASHINGTON ST, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:858-278-3636
Mailing Address - Fax:858-278-3637
Practice Address - Street 1:770 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2209
Practice Address - Country:US
Practice Address - Phone:858-278-3636
Practice Address - Fax:858-278-3637
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX763809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144644170Medicaid