| Doctor Name: | MS. JUDIANNE KEIGHTLY |
| NPI Number: | 1861895955 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP013644 |
| Business Practice Address: | 714 N Bethlehem Pike Suite 101 Lower Gwynedd, PA - 190022655 |
| Business Phone Number: | 2155404411 |
| Business Fax Number: | 2155404415 |
| Mailing Address: | 2500 Maryland Rd, Suite 400 WILLOW GROVE |
| State: | PA |
| Postal Code: | 190901216 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2014 |
| NPI Last Update Date: | 03/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | SP013644 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |