Provider Demographics
NPI:1457304883
Name:KEILITZ, JANE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:KEILITZ
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 1:606 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4336
Mailing Address - Country:US
Mailing Address - Phone:336-889-8877
Mailing Address - Fax:336-889-7832
Practice Address - Street 1:606 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4336
Practice Address - Country:US
Practice Address - Phone:336-889-8877
Practice Address - Fax:336-889-7832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103626363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71548Medicare UPIN
2756912Medicare ID - Type Unspecified