Individual
MARY J KEEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3660 VISTA AVE, SAINT LOUIS, MO 63110-2540
(314) 977-6100
(314) 977-6137
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
082605
MO
163WP2201X
Ambulatory Care Registered Nurse
082605
MO
363L00000X
Nurse Practitioner
082605
MO
363LA2100X
Acute Care Nurse Practitioner
082605
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
082605
MO
Other
Enumeration date
08/04/2006
Last updated
09/22/2023
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