Provider Demographics
NPI:1841897154
Name:KEEVER, ANDREA LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:KEEVER
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 1:4674 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:UNION MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28167-9100
Mailing Address - Country:US
Mailing Address - Phone:828-447-7072
Mailing Address - Fax:
Practice Address - Street 1:52 12TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2799
Practice Address - Country:US
Practice Address - Phone:828-447-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC001012128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program