Healthcare Provider Details

I. General information

NPI: 1750442323
Provider Name (Legal Business Name): CARLA A KEAHEY ACNS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA M ANDERSON APRN, BC

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/04/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 48TH ST STE 200
BOULDER CO
80301
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7450
  • Fax: 303-494-5265
Mailing address:
  • Phone: 303-415-7450
  • Fax: 303-494-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN.0992283-CNS
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994429-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: