Active NPI
Jennifer A Keough, ATC
- Athletic Trainer
- Ithaca, NY
National Provider Identifier
1174828339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 001958
- Practice address
- Teagle Hall, Campus Rd
Cornell University
Ithaca, NY 14853 - Phone
- (607) 255-4237
- NPI assigned
- Jan 20, 2011
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 001958 | NY | Primary |
Addresses
Primary practice location
Teagle Hall, Campus Rd
Cornell University
Ithaca, NY 14853
Mailing address
121 Ellery Rd
Rochester, NY 14612-2978
Phone (585) 227-2231
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001958 | NY | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295481600000",
"number": "1174828339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 ELLERY RD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146122978",
"telephone_number": "585-227-2231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "TEAGLE HALL, CAMPUS RD",
"address_2": "CORNELL UNIVERSITY",
"city": "ITHACA",
"state": "NY",
"postal_code": "14853",
"telephone_number": "607-255-4237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOUGH",
"first_name": "JENNIFER",
"middle_name": "A",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-20",
"last_updated": "2011-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "001958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.