Provider Demographics
NPI:1457617862
Name:KEYS, KRISTEN L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:L
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 1:102 CHURCHILL CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4320
Mailing Address - Country:US
Mailing Address - Phone:561-312-1346
Mailing Address - Fax:
Practice Address - Street 1:7051 SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5139
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-296-5287
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102751363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102751OtherLICENSE NUMBER