Healthcare Provider Details

I. General information

NPI: 1427336288
Provider Name (Legal Business Name): KEEGAN ROSE CULVER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 CAMINO REAL WAY
FORT MYERS FL
33966-1019
US

IV. Provider business mailing address

4461 CAMINO REAL WAY
FORT MYERS FL
33966-1019
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-1336
  • Fax:
Mailing address:
  • Phone: 239-936-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: