Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN181512 | GA |
NPI | 1023308301 |
---|---|
Provider Name | Patricia Ann Keegan |
First Address | Grayson, GA 30017-1499 |
Second Address | Atlanta, GA 30322-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 07/04/2011 |