Nelae Jontue Keene, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

21875 Issued in CA

Practice address

2787 Bristol St Ste 210
Costa Mesa, CA 92626-5956

Phone

(949) 515-7300

NPI assigned

Oct 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1790061208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2787 BRISTOL ST STE 210",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265956",
            "telephone_number": "949-515-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2787 BRISTOL ST STE 210",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265956",
            "telephone_number": "949-515-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Park Plz",
            "address_2": "Suite 600",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926145910",
            "country_code": "US",
            "telephone_number": "949-852-7377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEENE",
        "first_name": "NELAE",
        "middle_name": "JONTUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-28",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "21875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.