Healthcare Provider Details

I. General information

NPI: 1669797049
Provider Name (Legal Business Name): STEPHEN D KEEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 601495
CHARLOTTE NC
28260-1495
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2010
  • Fax: 843-724-2005
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberA721
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA721
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number721
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: