Provider Demographics
NPI:1598710113
Name:KEHOE, KEITH L (PAC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:KEHOE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:185 E PARKS HWY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7038
Mailing Address - Country:US
Mailing Address - Phone:907-373-4203
Mailing Address - Fax:907-373-4201
Practice Address - Street 1:MILE 4.2 TALKEETNA SPER RD
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676
Practice Address - Country:US
Practice Address - Phone:907-733-9205
Practice Address - Fax:907-733-1735
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKAA366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S13747Medicare UPIN