Individual
CAROLYN BURDETT KEOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
6150 150TH AVE N, CLEARWATER, FL 33760-2138
(727) 422-0352
Mailing address
8954 ANTIGUA DR, SEMINOLE, FL 33777-2144
(727) 421-8551
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
APRN11024878
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN11024878
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122759400
—
FL
Enumeration date
03/06/2023
Last updated
01/29/2025
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