Healthcare Provider Details

I. General information

NPI: 1063469864
Provider Name (Legal Business Name): SHAWN M O'KEEFE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 CAROLINA PLACE PKWY STE 100
PINEVILLE NC
28134-7471
US

IV. Provider business mailing address

11940 CAROLINA PLACE PKWY STE 100
PINEVILLE NC
28134-7471
US

V. Phone/Fax

Practice location:
  • Phone: 704-578-7273
  • Fax: 704-285-1125
Mailing address:
  • Phone: 704-578-7273
  • Fax: 704-285-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1877
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4261
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01452
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: