Provider Demographics
NPI:1639115835
Name:KEETER, HELENA GRACE (PA)
Entity Type:Individual
Prefix:MRS
First Name:HELENA
Middle Name:GRACE
Last Name:KEETER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:GRACE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-648-3902
Mailing Address - Fax:805-648-4014
Practice Address - Street 1:168 N BRENT ST STE 505
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-648-3902
Practice Address - Fax:805-648-4014
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17836AMedicare ID - Type Unspecified
CAQ46024Medicare UPIN