Provider Demographics
NPI:1184884454
Name:KEEFER, AMY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:KEEFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:DUNKELBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1244 STATE ROUTE 225
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:PA
Practice Address - Zip Code:17830-7324
Practice Address - Country:US
Practice Address - Phone:570-758-3511
Practice Address - Fax:570-758-4736
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053451363A00000X, 363AM0700X
PAOA002282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031512530002Medicaid
PA127222Medicare PIN