Provider Demographics
NPI:1871367011
Name:KEEGAN, KELSEY ANN
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 COUNTY ROAD 223
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-8574
Mailing Address - Country:US
Mailing Address - Phone:419-680-2236
Mailing Address - Fax:
Practice Address - Street 1:3060 COUNTY ROAD 223
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-8574
Practice Address - Country:US
Practice Address - Phone:419-680-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide