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NPI Code Detail

MEDICARE: MS. LAURIE KEOGH MPH, PA-C

MEDICARE: MS. LAURIE KEOGH MPH, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant2001NE

General Provider Information

NPI Number : 1336509181
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURIE KEOGH MPH, PA-C
Provider Business Mailing Address
First Line : 1113 SHERMAN ST
Second Line : PO BOX 406
City : SAINT PAUL
State : NE
Zip : 68873-1546
Country : US
Telephone Number : 308-754-4421
Fax Number : 308-754-4429
Provider Business Practice Location Address
First Line : 1113 SHERMAN ST
Second Line :
City : SAINT PAUL
State : NE
Zip : 68873-1546
Country : US
Telephone Number : 308-754-4421
Fax Number : 308-754-4429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2016
Last Update Date : 03/07/2016

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