Keith F. Moy PA STUDENT - Physician Assistant in Elk River, Minnesota | ProviderWire

Full Name

Keith Fertey Moy PA STUDENT

NPI Number

1275171795

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/16/2019

Specialties

(Taxonomies)

Name

Physician Assistant

Code

363A00000X

Primary Taxonomy

Yes

Licenses

State

Minnesota

License Number

13657

Contact
Information

Purpose

Mailing

Location

Address

8170 33RD AVE S

530 3RD ST NW

City

Bloomington

Elk River

State

MN

MN

Postal Code

55425-4516

55330-1445

Country

US

US

Telephone Number

N/A

(763) 587-4800

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/09/2021

Provider Address

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