Healthcare Provider Details

I. General information

NPI: 1033350442
Provider Name (Legal Business Name): KEILS KITCHEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 14TH AVE
SKAGWAY AK
99840-0537
US

IV. Provider business mailing address

PO BOX 537
SKAGWAY AK
99840-0537
US

V. Phone/Fax

Practice location:
  • Phone: 907-983-2255
  • Fax: 907-983-2793
Mailing address:
  • Phone: 907-983-2255
  • Fax: 907-983-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPADA854
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: