Healthcare Provider Details

I. General information

NPI: 1770660698
Provider Name (Legal Business Name): DENISE KEEGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BUSTLETON PIKE SUITE 200
FEASTERVILLE TREVOSE PA
19053-6446
US

IV. Provider business mailing address

1648 HUNTINGDON PIKE MEDICAL STAFF OFFICE 1ST FLR
MEADOWBROOK PA
19046-8001
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-0770
  • Fax: 215-464-8208
Mailing address:
  • Phone: 215-938-3450
  • Fax: 215-938-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP004415C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: