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Individual

MR. LEROY NEAL KEENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 798-5147
(208) 746-8741
Mailing address
320 WARNER DRIVE, LEWISTON, ID 83501
(208) 798-5147
(208) 746-8741

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004927
WA
363A00000X
Physician Assistant
Primary
PA645
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010154322
REGENCE
ID
05
8450645
WA
01
PAC08
BCI
ID
Enumeration date
11/16/2006
Last updated
12/26/2007
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