Healthcare Provider Details

I. General information

NPI: 1811342108
Provider Name (Legal Business Name): M. KATHRYN KEOGH MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATY KEOGH

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/18/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 VINE ST
CINCINNATI OH
45202-1141
US

IV. Provider business mailing address

PO BOX 830242
PHILADELPHIA PA
19182-0242
US

V. Phone/Fax

Practice location:
  • Phone: 855-699-6937
  • Fax: 800-546-2104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006004
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3099
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD005468
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2446
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2009
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0011113
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD.7274
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD.7274
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD.7274
License Number StateOH
# 10
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.7274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: