Provider Demographics
NPI:1427101385
Name:KEEFE, KATHERINE ELLEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELLEN
Last Name:KEEFE
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 1:146 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1413
Mailing Address - Country:US
Mailing Address - Phone:617-328-5382
Mailing Address - Fax:
Practice Address - Street 1:170 MORTON STREET
Practice Address - Street 2:LEMUEL SHATTUCK HOSPITAL
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical