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General NPI Number Information
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NPI Number | 1740980234
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Entity Type | Individual
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Provider Name | CAROLYN BURDETT KEOUGH PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 6150 150TH AVE N
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City | CLEARWATER
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State | FL
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Zip | 33760-2138
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Country | US
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Telephone | 727-422-0352
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Fax |
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Provider Business Mailing Address
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Address Line | 8954 ANTIGUA DR
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City | SEMINOLE
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State | FL
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Zip | 33777-2144
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Country | US
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Telephone | 727-421-8551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11024878
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | APRN11024878
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License Number State | FL
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