Provider Demographics
NPI:1669508024
Name:KEEVER, ROGER CLIFFORD (PA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CLIFFORD
Last Name:KEEVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MORGANTON BLVD SW
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4973
Mailing Address - Country:US
Mailing Address - Phone:828-426-8433
Mailing Address - Fax:
Practice Address - Street 1:2345 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4973
Practice Address - Country:US
Practice Address - Phone:828-426-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103238OtherNC MEDICAL BOARD PA LICEN