Provider Demographics
NPI:1134487168
Name:KEHOE, MICHAEL PATRICK (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:KEHOE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:645 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5017
Mailing Address - Country:US
Mailing Address - Phone:336-883-0029
Mailing Address - Fax:336-883-0867
Practice Address - Street 1:975 NC HIGHWAY 66 S
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3132
Practice Address - Country:US
Practice Address - Phone:336-883-0029
Practice Address - Fax:336-883-0867
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13997208VP0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine