Healthcare Provider Details

I. General information

NPI: 1194655092
Provider Name (Legal Business Name): MEGHAN KELLY KEATING PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN KELLY LYNCH PMHNP-BC

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 RIVERTOWN SHOPS DR STE 102
SAINT JOHNS FL
32259-7507
US

IV. Provider business mailing address

255 RIVERTOWN SHOPS DR STE 102
SAINT JOHNS FL
32259-7507
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-3799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047749
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2276960
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: