Provider Demographics
NPI:1194545806
Name:KEIM, PARKER ROSS (APCC)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:ROSS
Last Name:KEIM
Suffix:
Gender:X
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 REAM AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9768
Mailing Address - Country:US
Mailing Address - Phone:530-918-7200
Mailing Address - Fax:
Practice Address - Street 1:1107 REAM AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9768
Practice Address - Country:US
Practice Address - Phone:530-918-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20243390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program