Healthcare Provider Details

I. General information

NPI: 1760188379
Provider Name (Legal Business Name): MCKAYLA ELIZABETH KEOGH CERTIFIED DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CROSWELL ST
ALBANY NY
12206-1212
US

IV. Provider business mailing address

42 CROSWELL ST
ALBANY NY
12206-1212
US

V. Phone/Fax

Practice location:
  • Phone: 518-954-4343
  • Fax:
Mailing address:
  • Phone: 518-954-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: