Provider Demographics
NPI:1346864105
Name:KEFFER, AMANDA JO
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:KEFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:KEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 PARK PLACE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2068
Mailing Address - Country:US
Mailing Address - Phone:724-300-8028
Mailing Address - Fax:
Practice Address - Street 1:3000 PARK PLACE DR STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2068
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN657003163WP0808X
ID71441163WP0808X, 363LP0808X
PASP022136363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health