Healthcare Provider Details

I. General information

NPI: 1992042006
Provider Name (Legal Business Name): KATHRYN ANN KEOGH PHD, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 PARAGON PKWY SUITE 800
CLYDE NC
28721-9463
US

IV. Provider business mailing address

155 WILKINSON PASS LN APT 102
WAYNESVILLE NC
28786-8931
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-6675
  • Fax: 828-356-1115
Mailing address:
  • Phone: 828-452-6675
  • Fax: 828-356-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number155105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: