Individual
AMANDA KATHRYN KEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
119 GANNETT DR, SOUTH PORTLAND, ME 04106-6942
(207) 773-0040
(207) 661-4630
Mailing address
119 GANNETT DR, SOUTH PORTLAND, ME 04106-6942
(207) 773-0040
(207) 661-4630
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA1902
ME
363AS0400X
Surgical Physician Assistant
Primary
PA1902
ME
Other
Enumeration date
02/28/2019
Last updated
02/19/2020
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