Diane B Keckley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001067 Issued in CT

Practice address

1025 Silas Deane Hwy
Wethersfield, CT 06109-4229

Phone

(860) 696-2400

Fax

(860) 696-2410

NPI assigned

Dec 27, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: dkeckley9977@middlesexhealthprd.direct-ci.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.

• Hartford Physician Services PC

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1164404117

  Physician Assistant

  NPD (past)
• Potomac Physicians PA

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1790706844
  NPD (past)

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262736000000",
    "number": "1386621829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1086",
            "address_2": "HARTFORD MEDICAL GROUP",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951086",
            "telephone_number": "508-595-0531",
            "fax_number": "508-829-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094229",
            "telephone_number": "860-696-2400",
            "fax_number": "860-696-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KECKLEY",
        "first_name": "DIANE",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2010-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Journey to Success LLC
• Renee Dawn Kane
• Michael Gatobu Karani
• Mohan Kasaraneni, M.D.
• Stephanie L. Katz, D.M.D.
• Kimberly Keegan, NP-C
• Christian Keene
• Jill R Kenyon, MSPT
• Victoria Kerkhoff, SLP
• Key Human Services, Inc.

• Physician Assistant in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.