Provider Demographics
NPI:1992734388
Name:KEANE, PATRICA F (PHD, CNP)
Entity type:Individual
Prefix:
First Name:PATRICA
Middle Name:F
Last Name:KEANE
Suffix:
Gender:F
Credentials:PHD, CNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:FRANCES
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CNP
Mailing Address - Street 1:600 E GAMBIER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3705
Mailing Address - Country:US
Mailing Address - Phone:740-392-3732
Mailing Address - Fax:740-392-3732
Practice Address - Street 1:600 E GAMBIER ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3705
Practice Address - Country:US
Practice Address - Phone:740-392-3732
Practice Address - Fax:740-392-3732
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.163713-COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271778Medicaid
OH2271778Medicaid
OHHONP04411Medicare ID - Type Unspecified