Healthcare Provider Details

I. General information

NPI: 1528523719
Provider Name (Legal Business Name): AMY ELIZABETH KEENAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S GRADY WAY STE 400
RENTON WA
98057-3201
US

IV. Provider business mailing address

707 S GRADY WAY STE 400
RENTON WA
98057-3201
US

V. Phone/Fax

Practice location:
  • Phone: 866-686-2504
  • Fax: 833-445-5294
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3801
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61224178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: