Individual provider Active NPI

Kevin William Keane, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Devon, PA
National Provider Identifier
1417639469
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP027911 Issued in PA
Practice address
400 W Lancaster Ave
Devon, PA 19333-1531
Phone
(610) 999-6414
NPI assigned
Aug 1, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP027911 PA Primary

Addresses

Primary practice location

400 W Lancaster Ave
Devon, PA 19333-1531

Mailing address

1221 Plantation Dr
West Deptford, NJ 08086-2315
Phone (856) 628-7468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20231012000980 PA Practitioner - Nurse Practitioner 4789039645 Reassigns benefits to 1 organization
I20250404001430 NJ Practitioner - Nurse Practitioner 4789039645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
2 Crows LLCGroup PAC ID 0244652279, 8 clinicians

Practice addresses (Care Compare)

150 S Warner Rd
Suite 130
King of Prussia, PA 19406-2830
Phone (610) 510-4881

301 Birchfield Dr
Mount Laurel, NJ 08054-4005
Phone (610) 510-4881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP027911PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Wellness and Health LLC CurrentSince Sep 1, 2024 Accepting new patients
2 Crows LLC Psychiatric/Mental Health CurrentSince Sep 1, 2023 Accepting new patients

Locations

301 Birchfield Dr
Mount Laurel, NJ 08054
Phone (609) 923-4369

400 W Lancaster Ave
Ste 300
Devon, PA 19333
Phone (610) 510-4881

400 W Lancaster Ave
Devon, PA 19333
Phone (610) 851-4800

150 S Warner Rd
Ste 130
Kng of Prussa, PA 19406
Phone (610) 400-4885

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1417639469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 PLANTATION DR",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "080862315",
            "telephone_number": "856-628-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W LANCASTER AVE",
            "city": "DEVON",
            "state": "PA",
            "postal_code": "193331531",
            "telephone_number": "610-999-6414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEANE",
        "first_name": "KEVIN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-01",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP027911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Devon, PA

Sources for this page

Verify at the official NPI Registry.