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Individual

KATHLEEN ANNETTE KEOGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, CNP

Contact information

Practice address
1055 WESTGATE DR, SAINT PAUL, MN 55114-1065
(651) 635-9173
(612) 262-7989
Mailing address
16183 TAHINKA PL NW, PRIOR LAKE, MN 55372-1850

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R117190-9
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1027328-00
MN
Enumeration date
01/12/2007
Last updated
04/29/2011
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