Individual provider Active NPI

Jaron Keough, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Pawtucket, RI
National Provider Identifier
1477197820
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN02309 Issued in RI
Practice address
232 Pawtucket Ave Apt 1
Pawtucket, RI 02860-5169
Phone
(401) 710-1200
NPI assigned
Oct 29, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X RN56293 RI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN02309 RI Primary

Addresses

Primary practice location

232 Pawtucket Ave Apt 1
Pawtucket, RI 02860-5169

Mailing address

24 Burke St
Pawtucket, RI 02861-1918
Phone (401) 710-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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

Enrollment IDStateProvider typePAC IDDetails
I20200822000007 RI Practitioner - Nurse Practitioner 9537585419 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN02309RIMDPsychiatric/Mental Health Nurse Practitioner
RN56293RIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Quality Behavioral Health Single Specialty CurrentSince May 1, 2020 Accepting new patients

Locations

75 Lambert Lind Hwy
Warwick, RI 02886
Phone (401) 463-5778

75 Lambert Lind Hwy
Ste 120100
Warwick, RI 02886
Phone (401) 681-4274

Organizations & group practices 1

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": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1477197820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 BURKE ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028611918",
            "telephone_number": "401-710-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 PAWTUCKET AVE APT 1",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605169",
            "telephone_number": "401-710-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOUGH",
        "first_name": "JARON",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-29",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "RI",
            "license": "RN56293",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "RI",
            "license": "APRN02309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.