Provider Demographics
NPI:1396577599
Name:KEASCHE PSYCHIATRY
Entity type:Organization
Organization Name:KEASCHE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZAKISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:NP, PMHNP
Authorized Official - Phone:781-214-1166
Mailing Address - Street 1:500 WESTGATE DR # 1149
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1855
Mailing Address - Country:US
Mailing Address - Phone:781-214-1166
Mailing Address - Fax:
Practice Address - Street 1:500 WESTGATE DR # 1149
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1855
Practice Address - Country:US
Practice Address - Phone:781-214-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty