Provider Demographics
NPI:1417655598
Name:KEEN, ERICA PAIGE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:PAIGE
Last Name:KEEN
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 1:648 WINDSOR DR SE
Mailing Address - Street 2:
Mailing Address - City:BELVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9521
Mailing Address - Country:US
Mailing Address - Phone:910-547-6781
Mailing Address - Fax:
Practice Address - Street 1:240 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8346
Practice Address - Country:US
Practice Address - Phone:910-721-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant