Provider Demographics
NPI:1992042006
Name:KEOGH, KATHRYN ANN (PHD, MSN, RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:KEOGH
Suffix:
Gender:F
Credentials:PHD, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WILKINSON PASS LN
Mailing Address - Street 2:APT 102
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-8931
Mailing Address - Country:US
Mailing Address - Phone:828-452-6675
Mailing Address - Fax:828-356-1115
Practice Address - Street 1:157 PARAGON PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9463
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-356-1115
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC155105163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator