Provider Demographics
NPI:1265235378
Name:PEACEMAKER, KEELEY
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:PEACEMAKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ARCH RD
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8422
Mailing Address - Country:US
Mailing Address - Phone:304-257-7020
Mailing Address - Fax:
Practice Address - Street 1:54 ARCH RD
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8422
Practice Address - Country:US
Practice Address - Phone:304-257-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist