Provider Demographics
NPI:1962632331
Name:KEAYS, KATHLEEN A (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:KEAYS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25405 HANCOCK AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5978
Mailing Address - Country:US
Mailing Address - Phone:951-698-4600
Mailing Address - Fax:951-514-2542
Practice Address - Street 1:25405 HANCOCK AVE STE 216
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5978
Practice Address - Country:US
Practice Address - Phone:951-698-4600
Practice Address - Fax:951-514-2542
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant