Basic Information
| Provider Information | |||||||||
| NPI: | 1841258209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEEFE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLARKIN | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | KEEFE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2020 GENESEE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586168161 | ||||||||
| FaxNumber: | 8586168155 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 GENESEE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586168161 | ||||||||
| FaxNumber: | 8586168155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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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 | 207LH0002X | 212947 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | 207V00000X | 212947 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VH0002X | Q6337 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine | 207VX0201X | 212947 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207VH0002X | G83013 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 355303401 | 05 | TX | MEDICAID | 355303402 | 05 | TX | MEDICAID | 725746 | 01 | MA | TUFTS MEDICARE PREFERRED | OTHER | 97173903 | 01 | MA | NETWORK HEALTH | OTHER | 725746 | 01 | MA | TUFTS HEALTH PLAN | OTHER |