Healthcare Provider Details

I. General information

NPI: 1740813385
Provider Name (Legal Business Name): MOIRA KATHERINE KEECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOIRA KATHERINE WILLIAMS PA-C

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010-5469
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4427
  • Fax:
Mailing address:
  • Phone: 515-239-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: