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General NPI Number Information
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NPI Number | 1578932620
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Entity Type | Individual
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Provider Name | KATRINA MARGARET KEITHLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 9650 GROSS POINT RD STE 1900
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City | SKOKIE
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State | IL
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Zip | 60076-5006
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Country | US
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Telephone | 847-676-1112
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Fax | 847-674-3358
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE # 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone |
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Fax |
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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 | 5601007532
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License Number State | MI
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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 | 085006211
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License Number State | IL
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