Provider Demographics
NPI:1942916895
Name:KEH, MERA MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MERA MARIE
Middle Name:
Last Name:KEH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1415
Mailing Address - Country:US
Mailing Address - Phone:586-265-3895
Mailing Address - Fax:
Practice Address - Street 1:2 DEAN DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2765
Practice Address - Country:US
Practice Address - Phone:201-568-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17245700163WP0808X
NJNUR2023000861363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR17245700OtherRN
NJNUR2023000861OtherNP LICENSE