Active NPI
Gayle Keeshen
- Specialist
- Portland, ME
National Provider Identifier
1962624767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OT1641
- Practice address
- 1011 Forest Ave
Portland, ME 04103-3304 - Phone
- (207) 781-8881
- NPI assigned
- May 2, 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 |
|---|---|---|---|---|
| Specialist | 174400000X | OT1641 | ME | Primary |
Addresses
Primary practice location
1011 Forest Ave
Portland, ME 04103-3304
Mailing address
4 Ledgewood Dr
Falmouth, ME 04105-1897
Phone (207) 641-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT1641 | Medicaid | ME |
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 |
|---|---|---|---|
| OT1641 | ME | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487635200000",
"number": "1962624767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 LEDGEWOOD DR",
"city": "FALMOUTH",
"state": "ME",
"postal_code": "041051897",
"telephone_number": "207-641-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 FOREST AVE",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041033304",
"telephone_number": "207-781-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEESHEN",
"first_name": "GAYLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2017-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ME",
"license": "OT1641",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OT1641",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.