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Individual
KEELY M STATEN
Active
Individual
KEELY M STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112684
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106795900
—
FL
01
—
PA00357
LICENSE NUMBER
MS
Enumeration date
07/29/2018
Last updated
11/12/2022
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