MEDICARE: KYLEY MARISSA KEENE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.008490RX	OH

General Provider Information

NPI Number	:	1790564169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEY MARISSA KEENE PA-C

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE STE 2C
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2598
Country	:	US
Telephone Number	:	419-383-3759
Fax Number	:	419-383-2962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	01/15/2026

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Directions to “ KYLEY MARISSA KEENE PA-C” Practice Location

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