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: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 GOODHOPE CT
SAINT AUGUSTINE FL
32092-3354
US

IV. Provider business mailing address

66 GOODHOPE CT
SAINT AUGUSTINE FL
32092-3354
US

V. Phone/Fax

Practice location:
  • Phone: 917-513-1048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9700333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: