Basic Information
| Provider Information | |||||||||
| NPI: | 1750442323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEAHEY | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ACNS, FNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | CARLA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | APRN, BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5450 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034157450 | ||||||||
| FaxNumber: | 3034945265 | ||||||||
| Practice Location | |||||||||
| Address1: | 1755 48TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034157450 | ||||||||
| FaxNumber: | 3034945265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | APN.0992283-CNS | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health | 363LF0000X | APN.0994429-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.