Provider Demographics
NPI:1962154427
Name:KEEFE, JULIA A (FNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:KEEFE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 PADDY FIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-1522
Mailing Address - Country:US
Mailing Address - Phone:803-518-1922
Mailing Address - Fax:
Practice Address - Street 1:187 BUNCH FORD RD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-8224
Practice Address - Country:US
Practice Address - Phone:803-655-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC25747Medicaid