Provider Demographics
NPI:1114684685
Name:KECK, KRISHAN (CRNP)
Entity type:Individual
Prefix:MR
First Name:KRISHAN
Middle Name:
Last Name:KECK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVE STE 200L
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1746
Mailing Address - Country:US
Mailing Address - Phone:717-648-1269
Mailing Address - Fax:717-229-8051
Practice Address - Street 1:205 GRANDVIEW AVE STE 200L
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1746
Practice Address - Country:US
Practice Address - Phone:717-648-1269
Practice Address - Fax:717-229-8051
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily