Provider Demographics
NPI:1255809869
Name:KEYS, AMANDA AMY (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:AMY
Last Name:KEYS
Suffix:
Gender:F
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 1:11051 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-9434
Mailing Address - Country:US
Mailing Address - Phone:989-326-1048
Mailing Address - Fax:
Practice Address - Street 1:16440 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-8655
Practice Address - Country:US
Practice Address - Phone:989-583-0660
Practice Address - Fax:989-583-0669
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant