Healthcare Provider Details

I. General information

NPI: 1285326025
Provider Name (Legal Business Name): ASHLEY R KEEPES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 JAMES ST
LAWRENCEVILLE IL
62439-2027
US

IV. Provider business mailing address

2101 JAMES ST
LAWRENCEVILLE IL
62439-2027
US

V. Phone/Fax

Practice location:
  • Phone: 618-943-3302
  • Fax:
Mailing address:
  • Phone: 618-943-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28191205A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: