Healthcare Provider Details

I. General information

NPI: 1609413251
Provider Name (Legal Business Name): KEARA LEIGH EAGAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEARA LEIGH AHERN

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VILLAGE GREEN DR STE B
SWEDESBORO NJ
08085-3253
US

IV. Provider business mailing address

1020 LAUREL OAK RD STE 102
VOORHEES NJ
08043-3518
US

V. Phone/Fax

Practice location:
  • Phone: 856-467-7360
  • Fax: 856-467-5959
Mailing address:
  • Phone: 856-783-1777
  • Fax: 856-783-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00984200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: