Provider Demographics
NPI:1164559159
Name:KEYE, DEBORAH SUE (PAC PHYSICIAN ASSIST)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:KEYE
Suffix:
Gender:F
Credentials:PAC PHYSICIAN ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 S HIGHLAND DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3543
Mailing Address - Country:US
Mailing Address - Phone:801-272-4111
Mailing Address - Fax:801-272-5989
Practice Address - Street 1:4460 S HIGHLAND DR
Practice Address - Street 2:STE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3543
Practice Address - Country:US
Practice Address - Phone:801-272-4111
Practice Address - Fax:801-272-5989
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4821539-1206363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical