Healthcare Provider Details

I. General information

NPI: 1295320984
Provider Name (Legal Business Name): LYNN KEEFE, MD PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 PARTIN DR N STE 320
NICEVILLE FL
32578-1543
US

IV. Provider business mailing address

2600 PARTIN DR N STE 320
NICEVILLE FL
32578-1543
US

V. Phone/Fax

Practice location:
  • Phone: 118-503-0522
  • Fax: 850-279-6760
Mailing address:
  • Phone: 118-503-0522
  • Fax: 850-279-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNN MCDONNELL KEEFE
Title or Position: PRESIDENT
Credential: MD
Phone: 850-279-6260