Provider Demographics
NPI:1063054039
Name:KEESAMAN, HALEY MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:MARIE
Last Name:KEESAMAN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9350 SW STATE ROUTE J
Mailing Address - Street 2:
Mailing Address - City:OSBORN
Mailing Address - State:MO
Mailing Address - Zip Code:64474-9166
Mailing Address - Country:US
Mailing Address - Phone:605-464-0633
Mailing Address - Fax:
Practice Address - Street 1:802 N RIVERSIDE RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2508
Practice Address - Country:US
Practice Address - Phone:816-271-4025
Practice Address - Fax:816-271-4026
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023011685363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1221OtherSOUTH DAKOTA BOARD OF MEDICAL AND OSTEOPATHIC EXAMINERS