Basic Information
Provider Information | |||||||||
NPI: | 1407288434 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEEFER | ||||||||
FirstName: | VIRGINIA | ||||||||
MiddleName: | KYLINE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROSENBERRY | ||||||||
OtherFirstName: | VIRGINIA | ||||||||
OtherMiddleName: | KYLINE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 785 5TH AVE | ||||||||
Address2: | SUITE 3 | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172014232 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172639555 | ||||||||
FaxNumber: | 7172174218 | ||||||||
Practice Location | |||||||||
Address1: | 46 WALNUT BOTTOM RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | SHIPPENSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172578219 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175324148 | ||||||||
FaxNumber: | 7175323561 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2013 | ||||||||
LastUpdateDate: | 06/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP012996 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | RN548324 | PA | N |   | Nursing Service Providers | Registered Nurse |   |
ID Information
ID | Type | State | Issuer | Description | 100730726 0039 | 01 | PA | MEDICAID GROUP # | OTHER | 102858928 | 05 | PA |   | MEDICAID | 867633 | 01 | PA | MEDICARE GROUP # | OTHER |