Healthcare Provider Details

I. General information

NPI: 1144888397
Provider Name (Legal Business Name): KYLIE MARIE MCKEIGHAN PMHNP, LMHC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EMMA LN STE 402
CLIFTON PARK NY
12065-3705
US

IV. Provider business mailing address

4 EMMA LN STE 402
CLIFTON PARK NY
12065-3705
US

V. Phone/Fax

Practice location:
  • Phone: 518-557-1712
  • Fax: 518-557-1713
Mailing address:
  • Phone: 518-557-1712
  • Fax: 518-557-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408619
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: