# SHANE A KECK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1134308067
- **Gender:** Man
- **Credential:** MPA,PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1187 | KS | — |
| 363A00000X | Physician Assistant | PA60021277 | WA | Yes |

## Other

- **Enumeration date:** 10/27/2007
- **Last updated:** 09/04/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200536260A | — | KS |