Healthcare Provider Details

I. General information

NPI: 1639915853
Provider Name (Legal Business Name): KATRYN KEEFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S WYOMING AVE STE 2
EDWARDSVILLE PA
18704-3103
US

IV. Provider business mailing address

276 E END CTR
WILKES BARRE PA
18702-6970
US

V. Phone/Fax

Practice location:
  • Phone: 570-704-4233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA065686
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: