=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457617862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN L KEYS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2012
-----------------------------------------------------
Last Update Date | 12/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7051 SEACREST BLVD
-----------------------------------------------------
City | LANTANA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-5139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-296-5288
-----------------------------------------------------
Fax | 561-296-5287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 CHURCHILL CIR
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-312-1346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9102751
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9102751
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------