Provider Demographics
NPI:1811342108
Name:KEOGH, M. KATHRYN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:M. KATHRYN
Middle Name:
Last Name:KEOGH
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:KEOGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 830242
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1141
Practice Address - Country:US
Practice Address - Phone:855-699-6937
Practice Address - Fax:800-546-2104
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006004133V00000X
AL3099133V00000X
GALD005468133V00000X
KS2446133V00000X
SC2009133V00000X
DEDN-0011113133V00000X
OHLD.7274133VN1004X, 133VN1005X, 133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic