Provider Demographics
NPI:1528065760
Name:KEEGAN, EILEEN LONG (ARNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:LONG
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4649
Mailing Address - Country:US
Mailing Address - Phone:812-949-0405
Mailing Address - Fax:812-949-0445
Practice Address - Street 1:2305 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4649
Practice Address - Country:US
Practice Address - Phone:812-949-0405
Practice Address - Fax:812-949-0445
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002788363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics