Healthcare Provider Details

I. General information

NPI: 1356108773
Provider Name (Legal Business Name): KEYSTONE PNW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 N MULLAN RD STE B
SPOKANE VALLEY WA
99206-4094
US

IV. Provider business mailing address

826 N MULLAN RD STE B
SPOKANE VALLEY WA
99206-4094
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-7411
  • Fax: 509-342-7413
Mailing address:
  • Phone: 509-342-7411
  • Fax: 509-342-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAIME KEY
Title or Position: CEO
Credential: ARNP
Phone: 509-342-7411