Provider Demographics
NPI:1376547869
Name:KEYS, CONNIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:KEYS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3354
Mailing Address - Country:US
Mailing Address - Phone:269-969-6159
Mailing Address - Fax:269-969-6159
Practice Address - Street 1:265 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3354
Practice Address - Country:US
Practice Address - Phone:269-969-6159
Practice Address - Fax:269-969-6159
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN95730002Medicare ID - Type Unspecified