Active NPI
Susana McKeough, RN, FNP
- Nurse Practitioner
- San Rafael, CA
National Provider Identifier
1134527963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 7901
- Practice address
- 179 Acacia Avenue Room 100
Dominican University Student Health Center
San Rafael, CA 94901 - Phone
- (415) 485-3208
- Fax
- (415) 458-3755
- NPI assigned
- Dec 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 7901 | CA | Primary |
Addresses
Primary practice location
179 Acacia Avenue Room 100
Dominican University Student Health Center
San Rafael, CA 94901
Mailing address
50 Acacia Ave.
Student Health Center - Dominican University
San Rafael, CA 94901
Phone (415) 485-3208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7901 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418169600000",
"number": "1134527963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 ACACIA AVE.",
"address_2": "STUDENT HEALTH CENTER - DOMINICAN UNIVERSITY",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94901",
"telephone_number": "415-485-3208",
"fax_number": "415-458-3755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 ACACIA AVENUE ROOM 100",
"address_2": "DOMINICAN UNIVERSITY STUDENT HEALTH CENTER",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94901",
"telephone_number": "415-485-3208",
"fax_number": "415-458-3755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKEOUGH",
"first_name": "SUSANA",
"name_prefix": "Ms.",
"credential": "RN, FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-10",
"last_updated": "2014-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "7901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.