Provider Demographics
NPI:1053592972
Name:KEEFER BRIGHAM, ROBIN LUCASTA (PA-C)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LUCASTA
Last Name:KEEFER BRIGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-4101
Mailing Address - Country:US
Mailing Address - Phone:517-787-8015
Mailing Address - Fax:
Practice Address - Street 1:3165 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-4101
Practice Address - Country:US
Practice Address - Phone:517-787-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant