Healthcare Provider Details

I. General information

NPI: 1700819828
Provider Name (Legal Business Name): KIMBERLY SUSAN KEYES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ABBOTT ST STE 100
SALINAS CA
93901-4484
US

IV. Provider business mailing address

5949 BUFORD HWY
NORCROSS GA
30071-2472
US

V. Phone/Fax

Practice location:
  • Phone: 831-751-7070
  • Fax:
Mailing address:
  • Phone: 678-280-6630
  • Fax: 648-280-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA5363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: