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General NPI Number Information
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NPI Number | 1407417116
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Entity Type | Individual
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Provider Name | KEYA THAKKAR PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 593 EDDY STREET APC 4
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City | PROVIDENCE
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State | RI
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Zip | 02903
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Country | US
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Telephone | 401-444-4700
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Fax | 401-444-6681
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Provider Business Mailing Address
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Address Line | PO BOX 16149
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City | RUMFORD
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State | RI
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Zip | 02916-0697
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Country | US
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Telephone | 401-228-7248
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Fax | 401-784-4913
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01352
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA7379
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License Number State | MA
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