Diane M Keehn, PA-C
Individual provider Active NPI Physician Assistant · Edgerton, WI
NPI 1194883512 · NPPES record last updated Aug 22, 2022
Key facts
- NPI
- 1194883512
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1456 (WI)
- Practice address
- 11051 N Sherman Rd
Edgerton, WI 53534-9002 - Phone
- (608) 884-3354
- Fax
- (608) 884-5022
- NPI assigned
- Dec 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1564 | AZ | MD | Dentist |
| 1456 | WI | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1456 | WI | |
| Physician Assistant | 363A00000X | 1456 | WI | Yes |
Addresses
Primary practice location
11051 N Sherman Rd
Edgerton, WI 53534-9002
Mailing address
11051 N Sherman Rd
Edgerton, WI 53534-9002
Phone (608) 884-3354
Other practice location 1
6750 W Fenrick Rd
Evansville, WI 53536
Phone (608) 201-6817
Other practice location 2
6750 W Fenrick Rd
Evansville, WI 53536
Phone (608) 201-6817
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194883512 | Medicaid | WI |
Other names
- Diane M Wilke
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dkeehn309041@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
Other providers in Edgerton, WI
- Deboree I Hopkins
- Matthew Mark Houfe
- Terry E Johnson
- Jr Lee Psychotherapy Services & Consultation, LTD.
- Fauna K Justman
- Diana L King
- Erika Kipper
- Tiffany Klemp
- Kurtz Chiropractic Office, LLC
- Robert C Kurtz
All providers in Edgerton, WI · Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.