Healthcare Provider Details

I. General information

NPI: 1437725215
Provider Name (Legal Business Name): KEELEY BASKIN CLANAHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 WELLNESS WAY STE 315
WEST CHESTER OH
45069-2509
US

IV. Provider business mailing address

9505 MONTGOMERY RD STE 201
MONTGOMERY OH
45242-7248
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7600
  • Fax: 513-475-7690
Mailing address:
  • Phone: 513-815-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number483788
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number29041
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029041
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: