Individual
MR. KEITH A PLAMONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1001 DIVISION ST, PRESCOTT, AZ 86301-1601
(928) 775-5567
(928) 772-1522
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2279
AZ
363AM0700X
Medical Physician Assistant
2279
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2279
MEDICAL LICENSE
AZ
05
—
495003
—
AZ
Enumeration date
07/19/2006
Last updated
02/17/2025
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