Healthcare Provider Details

I. General information

NPI: 1558307066
Provider Name (Legal Business Name): TANYA B. KEELEY P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA D., BROUSSEAU PA-C

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BEAVERDAM RD
ASHEVILLE NC
28804-1806
US

IV. Provider business mailing address

25 GLEN COE DR
FLETCHER NC
28732-5515
US

V. Phone/Fax

Practice location:
  • Phone: 727-743-6715
  • Fax:
Mailing address:
  • Phone: 727-743-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16761
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: