Provider Demographics
NPI:1407288434
Name:KEEFER, VIRGINIA KYLINE (CRNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:KYLINE
Last Name:KEEFER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:KYLINE
Other - Last Name:ROSENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:46 WALNUT BOTTOM RD STE 200
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8219
Practice Address - Country:US
Practice Address - Phone:717-532-4148
Practice Address - Fax:717-532-3561
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012996363LF0000X
PARN548324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100730726 0039OtherMEDICAID GROUP #
PA102858928Medicaid
PA867633OtherMEDICARE GROUP #