Provider Demographics
NPI:1588697379
Name:KEGLER, KAREN SUE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:KEGLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5205
Mailing Address - Country:US
Mailing Address - Phone:810-987-6200
Mailing Address - Fax:
Practice Address - Street 1:1225 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-987-6200
Practice Address - Fax:810-987-8717
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704185983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4937643Medicaid
MIQ78402Medicare UPIN
MI4937643Medicaid