Provider Demographics
NPI:1457767956
Name:KEEHN, NICOLE (RN, MS(N), PSYD, LPA)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:KEEHN
Suffix:
Gender:F
Credentials:RN, MS(N), PSYD, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3046
Mailing Address - Country:US
Mailing Address - Phone:972-923-0730
Mailing Address - Fax:972-923-3886
Practice Address - Street 1:508 GRACE ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3046
Practice Address - Country:US
Practice Address - Phone:972-923-0730
Practice Address - Fax:972-923-3886
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36816103TC0700X
TX546040163WC1600X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program