Healthcare Provider Details

I. General information

NPI: 1164755112
Provider Name (Legal Business Name): SALLY LYNN KEOGH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 41ST ST OCEAN GUIDANCE CLINIC OF THE MIDDLE KEYS
MARATHON FL
33050
US

IV. Provider business mailing address

1224 ROGERS LN
CUDJOE KEY FL
33042-4324
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-9000
  • Fax: 305-434-9041
Mailing address:
  • Phone: 678-451-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5150334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: