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KATHLEEN KEITHLEY PA-C NPI 1760457352


NPI Information

NPI: 1760457352
Provider Name: KATHLEEN KEITHLEY, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: MERCY CLINIC GASTROENTEROLOGY LLC

PECOS Registration: Yes

Address:
340 W LINCOLN ST
BELLEVILLE, IL
ZIP 62220
Phone: (618) 233-6044
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Kathleen Keithley, PA-C is a medical physician assistant in Belleville, IL with 21 years of experience. Kathleen Keithley, PA-C NPI is 1760457352. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

340 W LINCOLN ST
BELLEVILLE, IL
ZIP 62220-900
Phone: (618) 233-6044
Fax: (618) 233-3287

The NPI 1760457352 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/17/2006 and was last updated on 11/5/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363AM0700XPhysician AssistantMedical2003029518MISSOURINo
2363AM0700XPhysician AssistantMedicalILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q30980MEDICARE UPINMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.