Provider Demographics
NPI:1396473948
Name:HARVEY, KEITH MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:MICHAEL
Last Name:HARVEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 HUNTRESS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3451
Mailing Address - Country:US
Mailing Address - Phone:210-560-7441
Mailing Address - Fax:
Practice Address - Street 1:2833 BABCOCK RD STE 435
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4850
Practice Address - Country:US
Practice Address - Phone:210-705-5060
Practice Address - Fax:210-705-5171
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19319363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program