Provider Demographics
NPI:1104922400
Name:O'KEEFE, TAWNYA D (NP)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:D
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAWNYA
Other - Middle Name:D
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:204 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2810
Mailing Address - Country:US
Mailing Address - Phone:208-797-3597
Mailing Address - Fax:
Practice Address - Street 1:420 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2989
Practice Address - Country:US
Practice Address - Phone:208-797-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP421-A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
13429732OtherMEDICARE PTAN
1370136OtherMEDICARE GROUP PTAN
ID805757300Medicaid
ID8080036Medicaid
PO6909Medicare UPIN