Provider Demographics
NPI:1194506741
Name:KEEHR, NICOLETTE RENEE (DNP, AGNP-C)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:RENEE
Last Name:KEEHR
Suffix:
Gender:
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:RENEE
Other - Last Name:GAMACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15861 GARDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7006
Mailing Address - Country:US
Mailing Address - Phone:612-787-6289
Mailing Address - Fax:
Practice Address - Street 1:15861 GARDEN VIEW DR
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7006
Practice Address - Country:US
Practice Address - Phone:612-787-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10856363LG0600X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care