Provider Demographics
NPI:1467628883
Name:KEEFER, LARRY K (PNP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:K
Last Name:KEEFER
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7120
Mailing Address - Country:US
Mailing Address - Phone:269-969-8723
Mailing Address - Fax:269-969-8724
Practice Address - Street 1:2545 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7120
Practice Address - Country:US
Practice Address - Phone:269-969-8723
Practice Address - Fax:269-969-8724
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704109385363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics