Provider Demographics
NPI:1063434462
Name:KEHOE, MARY IRENE (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:IRENE
Last Name:KEHOE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TERRAPIN CLOSE
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-8945
Mailing Address - Country:US
Mailing Address - Phone:256-757-2244
Mailing Address - Fax:
Practice Address - Street 1:422 COX BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4000
Practice Address - Country:US
Practice Address - Phone:256-381-9055
Practice Address - Fax:256-381-6101
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-060812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily