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NPI Code Detail

MEDICARE: KRISTA MICHELLE KEITH DO

MEDICARE: KRISTA MICHELLE KEITH DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS8525FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1293098OTHERAVMED
27010522OTHERAETNA

General Provider Information

NPI Number : 1891729513
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA MICHELLE KEITH DO
Provider Business Mailing Address
First Line : 12020 SEMINOLE BLVD
Second Line : SUNCOAST FAMILY MEDICAL ASSOCIATES
City : LARGO
State : FL
Zip : 33778-2805
Country : US
Telephone Number : 727-588-9572
Fax Number : 727-584-3832
Provider Business Practice Location Address
First Line : 12020 SEMINOLE BLVD
Second Line : SUNCOAST FAMILY MEDICAL ASSOCIATES
City : LARGO
State : FL
Zip : 33778-2805
Country : US
Telephone Number : 727-588-9572
Fax Number : 727-584-3832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 06/18/2010

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Directions to “ KRISTA MICHELLE KEITH DO” Practice Location

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