Provider Demographics
NPI:1699972356
Name:KEYSER, MELISSA K (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:KEYSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:K
Other - Last Name:RADAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PAC
Mailing Address - Street 1:124 HOME DEPOT DR STE D
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-8002
Mailing Address - Country:US
Mailing Address - Phone:814-677-2262
Mailing Address - Fax:
Practice Address - Street 1:148 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3734
Practice Address - Country:US
Practice Address - Phone:740-346-2702
Practice Address - Fax:740-346-2645
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002383RX363AM0700X
PAMA053803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102803Medicaid
OHH316390Medicare PIN
OH0102803Medicaid