Provider Demographics
NPI:1508890096
Name:KEEFE, AMY B (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:KEEFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:B
Other - Last Name:BLASZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:118 NATURE PARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6960
Mailing Address - Country:US
Mailing Address - Phone:724-219-3977
Mailing Address - Fax:412-856-5871
Practice Address - Street 1:118 NATURE PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6960
Practice Address - Country:US
Practice Address - Phone:724-219-3977
Practice Address - Fax:412-856-5871
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052542363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11947724OtherCAQH
PA50059525OtherKEYSTONE CENTRAL
PAQ71470Medicare UPIN
PA103519EDCMedicare ID - Type Unspecified