Healthcare Provider Details

I. General information

NPI: 1740846575
Provider Name (Legal Business Name): KATELYN VICTORIA KEEFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN VICTORIA HOAGLAND PA-C

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 02/21/2024
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 7TH AVE N
ST PETERSBURG FL
33705-1348
US

IV. Provider business mailing address

1109 118TH TER N
ST PETERSBURG FL
33716-1507
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-1661
  • Fax:
Mailing address:
  • Phone: 727-455-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: