Individual
MR. KEITH A BERENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
125 BAPTIST WAY STE 4C, PENSACOLA, FL 32503-2274
(448) 227-6330
(850) 626-9606
Mailing address
PO BOX 95590, SOUTH JORDAN, UT 84095-0590
(801) 784-0954
(801) 352-7976
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2814
NH
363AS0400X
Surgical Physician Assistant
Primary
PA9101561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291015200
—
FL
01
—
59039584
BSAL
FL
Enumeration date
11/18/2005
Last updated
02/23/2026
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