Healthcare Provider Details

I. General information

NPI: 1902127491
Provider Name (Legal Business Name): MARILYN C KEEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN C COWLES PA-C

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-0531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3188
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3188
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: