MR. JUSTIN KEADLE (NPI# 1801210026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801210026 |
| Entity Type | Individual |
| Full Name | MR. JUSTIN KEADLE |
| Credential | PA-C |
| Practice Address |
1010 Murray Ave San Luis Obispo CA 93405-1806 |
| Practice Telephone | 8055461997 |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2016-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | C05327 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA53511 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1010 MURRAY AVE |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93405-1806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083687354 | Paul J Wolfrom | Anesthesiology | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2006-02-08 |
| 1306498464 | Megan Christine Smith | Registered Nurse | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2019-07-09 |
| 1982102000 | Shilpa Patel | Pharmacist | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2018-01-23 |
| 1326572116 | Christopher Walheim | Hospitalist | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2017-04-18 |
| 1285088211 | Cindy Hsiang Su | Hospitalist | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2016-04-15 |
| 1780046243 | Olga Grigorieva Olson | Hospitalist | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2016-03-24 |
| 1114393279 | Lisa Randolph | Nurse Practitioner | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2015-08-12 |
| 1568856474 | Kyle Richard Kelson | Emergency Medicine | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2015-03-28 |
| 1154736734 | Sean Andrews | Emergency Medicine | 1010 Murray Ave, San Luis Obispo, CA 93405-1806 | 2014-06-23 |
| 1801235320 | John Lee Bass | Nurse Practitioner | 1010 Murray Ave, Trauma & Emergency Surgery, Svrmc, San Luis Obispo, CA 93405-1806 | 2013-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076626 | Hilary Abbott Anderson | Physician Assistant | 127 Casa St., San Luis Obispo, CA 93405 | 2019-08-01 |
| 1811465834 | Fatemeh Ladan Ahmadinia | Dentist | 764 N Santa Rosa St, San Luis Obispo, CA 93405 | 2018-11-07 |
| 1538559794 | Arnold Martin Horwitz | Marriage & Family Therapist | 1605 Garnette Drive, San Luis Obispo, CA 93405 | 2015-01-27 |
| 1750794764 | Solmaz Naghsh | Pharmacist | 765 Foothill Blvd, San Luis Obispo, CA 93405 | 2014-06-06 |
| 1609293471 | Robert S. Flores Dmd, Inc | Dentist | 878 Boysen Avenue, San Luis Obispo, CA 93405 | 2014-03-18 |
| 1457776445 | Laura Anne Wilvert | Marriage & Family Therapist | 793 E. Foothill Blvd, Suite A, #278, San Luis Obispo, CA 93405 | 2014-02-27 |
| 1497181200 | Tracey Ruby Madrigal | Counselor | 1106 Oceanaire Dr. #25, San Luis Obispo, CA 93405 | 2013-09-25 |
| 1437597572 | Sarah Michelle Brenis | Counselor | 524 Princeton Place, San Luis Obispo, CA 93405 | 2013-06-11 |
| 1013350974 | Jenna Rose Ramos | Counselor | 1459 Descanso St., San Luis Obispo, CA 93405 | 2013-04-10 |
| 1700140696 | Christopher Dieterich Marchand | Social Worker | 793a E. Foothill Blvd, 190, San Luis Obispo, CA 93405 | 2012-06-26 |
| Find all providers in zip 93405 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649894403 | Kathlyn Larco | Physician Assistant | 1233 W Randall Way, West Covina, CA 91790-4747 | 2020-06-07 |
| 1487126421 | Eliza Hughes | Physician Assistant | 860 Oak Park Blvd Ste 101, Arroyo Grande, CA 93420-1800 | 2018-12-31 |
| 1508333873 | Andrew Cantos Malit | Physician Assistant | 409 Bristol Way, Corona, CA 92879-6156 | 2018-10-25 |
| 1578049458 | Ida Jelveh | Physician Assistant | 28096 Edelweiss Ct, Laguna Niguel, CA 92677-7006 | 2018-07-13 |
| 1356833578 | Michael James Gonzalez | Physician Assistant | 1500 E Chevy Chase Dr # 401a401b, Glendale, CA 91206-4152 | 2018-06-04 |
| 1023500592 | Pamela Lambert Pa-c, Inc. | Physician Assistant | 16105 Mariposa Ave, Riverside, CA 92504-8730 | 2018-05-31 |
| 1225532385 | Folsom Physicain Assistant First Assist, Inc | Physician Assistant | Nina Vasiliev Pa-c, 15407 Muller Rd, Plymouth, CA 95669-9770 | 2018-03-22 |
| 1275040008 | Gm Surgical Assistant Inc | Physician Assistant | 15615 Turnberry St, Moreno Valley, CA 92555-4901 | 2018-01-02 |
| 1902311186 | Or Solutions Inc | Physician Assistant | 1501 Secret Ravine Pkwy Unit 527, Roseville, CA 95661-6005 | 2017-12-09 |
| 1184143828 | Alaa Abdalla Daghlas | Physician Assistant | 1100 S Eliseo Dr Ste A, Greenbrae, CA 94904-2017 | 2017-09-13 |
| Find all providers with the same taxonomy | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.