Jill C Keogh, MSW, LCSW

Key facts

NPI

1124259619

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

3074 (KY)

Practice address

3121 Comanche TRL
Lexington, KY 40503-5472

Phone

(859) 338-6090

Fax

(859) 223-1062

NPI assigned

Jul 31, 2009

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 5, 2013.

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1124259619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 COMANCHE TRL",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405035472",
            "telephone_number": "859-338-6090",
            "fax_number": "859-223-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 COMANCHE TRL",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405035472",
            "telephone_number": "859-338-6090",
            "fax_number": "859-223-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOGH",
        "first_name": "JILL",
        "middle_name": "C",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-31",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100116760",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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