Healthcare Provider Details

I. General information

NPI: 1376046177
Provider Name (Legal Business Name): CAITLIN KECKEIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 11/19/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD # MLC16078
LIBERTY TOWNSHIP OH
45044-3500
US

IV. Provider business mailing address

7777 YANKEE RD # MLC16078
LIBERTY TOWNSHIP OH
45044-3500
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-8790
  • Fax: 513-803-8406
Mailing address:
  • Phone: 513-636-8790
  • Fax: 513-803-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022263
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.385891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: