Provider Demographics
NPI:1386183994
Name:HASELEY, KEITH BRANDON (PA-C)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:BRANDON
Last Name:HASELEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:319 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2518
Practice Address - Country:US
Practice Address - Phone:843-203-2246
Practice Address - Fax:843-203-2247
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020599363A00000X
SC5566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant