Active NPI
Kathleen B Keane, LP
- Psychologist
- White Bear Lake, MN
National Provider Identifier
1417052465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3569
- Practice address
- 1310 Highway 96 E
White Bear Lake, MN 55110-3624 - Phone
- (651) 714-8007
- NPI assigned
- Sep 14, 2006
- Last updated
- Aug 3, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3569 | MN | Primary |
Addresses
Primary practice location
1310 Highway 96 E
White Bear Lake, MN 55110-3624
Mailing address
5696 Windmill Dr
White Bear Lake, MN 55110-2284
Phone (651) 714-8007
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 |
|---|---|---|---|
| 3569 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186099200000",
"number": "1417052465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5696 WINDMILL DR",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551102284",
"telephone_number": "651-714-8007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 HIGHWAY 96 E",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551103624",
"telephone_number": "651-714-8007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEANE",
"first_name": "KATHLEEN",
"middle_name": "B",
"credential": "LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-14",
"last_updated": "2007-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "3569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.