Provider Demographics
NPI:1396421012
Name:KEANE, CARRIE-ANNE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CARRIE-ANNE
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14348 COURTNEY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1884
Mailing Address - Country:US
Mailing Address - Phone:772-240-4282
Mailing Address - Fax:
Practice Address - Street 1:3203 WILTON LN E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2315
Practice Address - Country:US
Practice Address - Phone:253-533-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027127363LP0808X
WAAP61561470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health