Provider Demographics
NPI:1215946876
Name:KEHOE, KEATHER ALIX (MD)
Entity type:Individual
Prefix:
First Name:KEATHER
Middle Name:ALIX
Last Name:KEHOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 LAGUNA BLVD
Mailing Address - Street 2:SUITE 105-PMB 364
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7037
Mailing Address - Country:US
Mailing Address - Phone:916-429-4230
Mailing Address - Fax:916-429-4223
Practice Address - Street 1:925 SECRET RIVER DR
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3465
Practice Address - Country:US
Practice Address - Phone:916-429-4230
Practice Address - Fax:916-429-4223
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 0700382084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A700380Medicare ID - Type Unspecified