Provider Demographics
NPI:1851392419
Name:PURINO, KEITH J (PA-C)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:PURINO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GLEN ECHO RD STE 111
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2857
Mailing Address - Country:US
Mailing Address - Phone:615-657-4800
Mailing Address - Fax:954-657-4800
Practice Address - Street 1:2000 GLEN ECHO RD STE 111
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215
Practice Address - Country:US
Practice Address - Phone:615-657-4800
Practice Address - Fax:954-337-2733
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN718363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S82272Medicare UPIN
TN3668494Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B