Provider Demographics
NPI:1255569463
Name:KEIM, GINA L (PA-C)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:KEIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:LEE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8606 VILLAGE DR
Mailing Address - Street 2:STE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5506
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-590-7288
Practice Address - Street 1:525 OAK CENTRE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3944
Practice Address - Country:US
Practice Address - Phone:210-297-4560
Practice Address - Fax:210-297-0451
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02304363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02304OtherPHYSICIAN ASSISTANT PERMIT