Healthcare Provider Details

I. General information

NPI: 1245741685
Provider Name (Legal Business Name): CELESTE DONYELLE KEPPLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CLAIRTON BLVD
WEST MIFFLIN PA
15236-1426
US

IV. Provider business mailing address

1411 ROLLING ACRES RD
LATROBE PA
15650-4714
US

V. Phone/Fax

Practice location:
  • Phone: 412-650-2900
  • Fax:
Mailing address:
  • Phone: 724-832-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059497
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: