Provider Demographics
NPI:1750442323
Name:KEAHEY, CARLA A (ACNS, FNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:KEAHEY
Suffix:
Gender:F
Credentials:ACNS, FNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-7450
Mailing Address - Fax:303-494-5265
Practice Address - Street 1:1755 48TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-415-7450
Practice Address - Fax:303-494-5265
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992283-CNS364SA2200X
COAPN.0994429-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2023459-01Medicaid
TX2023459-01Medicaid