Tararoth Pen Keo

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95029648 Issued in CA

Practice address

43932 15TH St W Ste 103
Lancaster, CA 93534-5234

Phone

(661) 945-7755

NPI assigned

Apr 8, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Unified Health AssociatesGroup PAC ID 0749664910, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Antelope Valley Hospital Hospital, Lancaster, CA, CCN 050056

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/adcf8c94-9b00-4842-a377-0e772d7d3145/
• Direct secure messaging: tararoth.keo.p15@direct.hdmgipa.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Unified Health Associates

  • Multi-Specialty Clinic/Center
  • Lancaster, CA
  • NPI 1326773672
  Medicare reassignment Care Compare group NPD
• Antelope Valley Kidney Institute, a Professional Corporation

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lancaster, CA
  • NPI 1770609711
  NPD (past)
• Horizon Multicare Group Inc

  • Internal Medicine Physician
  • Lancaster, CA
  • NPI 1598130569
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Antelope Valley Health Care District

  • General Acute Care Hospital
  • Lancaster, CA
  • NPI 1366419517
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1205689783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 BRIANNA AVE",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935352931",
            "telephone_number": "661-902-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43932 15TH ST W STE 103",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935345234",
            "telephone_number": "661-945-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEO",
        "first_name": "TARAROTH",
        "middle_name": "PEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95029648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clive Dale Kennedy, PH.D.
• Devon Kennedy, O.D.
• Jeremy Ryan Kennedy, RN
• Philip Douglas Kennedy, DC
• Kenneth W. Malone, DDS, PC
• Mikayla Erin Kerchen
• Kathleen Kessler, LCSW83460
• Lisa Kathleen Kettelkamp
• Kevin Ju, DDS, Inc.
• George O. Kevly, M.D.

• Family Nurse Practitioner in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.