Provider Demographics
NPI:1770622862
Name:MYERS, KEITH CHESTER (PA-C)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:CHESTER
Last Name:MYERS
Suffix:
Gender:M
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 1:2620 MARSH WREN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8185
Mailing Address - Country:US
Mailing Address - Phone:530-846-9072
Mailing Address - Fax:
Practice Address - Street 1:2620 MARSH WREN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8185
Practice Address - Country:US
Practice Address - Phone:530-846-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant