Provider Demographics
NPI:1215125653
Name:KEYS, LISA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
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 1:110 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2130
Mailing Address - Country:US
Mailing Address - Phone:860-945-7777
Mailing Address - Fax:860-945-7766
Practice Address - Street 1:110 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2130
Practice Address - Country:US
Practice Address - Phone:860-945-7777
Practice Address - Fax:860-945-7766
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant