Provider Demographics
NPI:1285239426
Name:KEINER, KATHLEEN MARIE (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:KEINER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1655 BERNARDIN AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2039
Mailing Address - Country:US
Mailing Address - Phone:803-253-7575
Mailing Address - Fax:855-257-9322
Practice Address - Street 1:1655 BERNARDIN AVE STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2039
Practice Address - Country:US
Practice Address - Phone:803-253-7575
Practice Address - Fax:855-257-9322
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2021-03-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant