Healthcare Provider Details

I. General information

NPI: 1730690231
Provider Name (Legal Business Name): CASEY KEEGAN DNP, APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FRANKLIN TPKE
RIDGEWOOD NJ
07450-1903
US

IV. Provider business mailing address

196 SPEEDWELL AVE
MORRISTOWN NJ
07960-2934
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-1700
  • Fax:
Mailing address:
  • Phone: 973-539-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00773300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: