Provider Demographics
NPI:1578932620
Name:KEITHLEY, KATRINA MARGARET (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MARGARET
Last Name:KEITHLEY
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:2650 RIDGE AVE # 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9650 GROSS POINT RD STE 1900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:847-676-1112
Practice Address - Fax:847-674-3358
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2025-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007532363A00000X
IL085006211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant