Individual
MR. KEITH STEPHEN PERNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-1868
Mailing address
42427 IBEX DR, STERLING, VA 20166-2234
(808) 375-7717
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007956
VA
363A00000X
Physician Assistant
PA20001279
DC
Other
Enumeration date
11/15/2021
Last updated
01/04/2024
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