Healthcare Provider Details

I. General information

NPI: 1669192589
Provider Name (Legal Business Name): KEEGAN MICHAEL SCOFIELD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 09/08/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 W MARKET ST STE 101
CORNING NY
14830-2600
US

IV. Provider business mailing address

23 W MARKET ST STE 101
CORNING NY
14830-2600
US

V. Phone/Fax

Practice location:
  • Phone: 607-846-3960
  • Fax: 607-973-2309
Mailing address:
  • Phone: 607-846-3960
  • Fax: 607-973-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: