Provider Demographics
NPI:1053963579
Name:O'KEEFFE, BESS DAVINA LAWRIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BESS
Middle Name:DAVINA LAWRIE
Last Name:O'KEEFFE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:571-291-9786
Practice Address - Street 1:19441 GOLF VISTA PLZ STE 230
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8271
Practice Address - Country:US
Practice Address - Phone:703-729-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110006862363A00000X
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty