Provider Demographics
NPI:1972900157
Name:KEENEY, VINCENT PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:PATRICK
Last Name:KEENEY
Suffix:
Gender:M
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 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8755
Mailing Address - Country:US
Mailing Address - Phone:252-443-0400
Mailing Address - Fax:252-443-0572
Practice Address - Street 1:110 PATRICK CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8755
Practice Address - Country:US
Practice Address - Phone:252-443-0400
Practice Address - Fax:252-443-0572
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-62848363A00000X
NC0010-05455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant