Basic Information
| Provider Information | |||||||||
| NPI: | 1497792352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEASHLY | ||||||||
| FirstName: | RAE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 PLEASANT AVE S | ||||||||
| Address2: | |||||||||
| City: | PARK RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564701440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187322800 | ||||||||
| FaxNumber: | 2187322857 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 PLEASANT AVE S | ||||||||
| Address2: | |||||||||
| City: | PARK RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564701440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187322800 | ||||||||
| FaxNumber: | 2187322857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38837 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0403067 | 01 | MN | MEDICA # | OTHER | 23Y87KE | 01 | MN | MNBS # | OTHER | 23Y89KE | 01 | MN | MNBS # | OTHER | 8050 | 01 | MN | SIOUX VALLEY # | OTHER | 0106730 | 01 | MN | MEDICA # | OTHER | 975817800 | 05 | MN | MEDICAID | MN100030 | 01 | MN | LHS/BANNERHEALTH # | OTHER | 0106547 | 01 | MN | MEDICA # | OTHER | 140791 | 01 | MN | UCARE # | OTHER | 18686 | 05 | MN | MEDICAID | DA9041015676 | 01 | MN | PREFERRED ONE # | OTHER | 904360 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | HP25788 | 01 | MN | HEALTHPARTNERS # | OTHER | 14173 | 01 | MN | NDBS # | OTHER | 23Y88KE | 01 | MN | MNBS # | OTHER |