Provider Demographics
NPI:1225073927
Name:KEYSER, KIRSTEN
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:KEYSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BARTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-4806
Mailing Address - Country:US
Mailing Address - Phone:518-295-8521
Mailing Address - Fax:518-295-7911
Practice Address - Street 1:111 BARTON HILL RD
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-4806
Practice Address - Country:US
Practice Address - Phone:518-295-8521
Practice Address - Fax:518-295-7911
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11250OtherLICENSE