Heidi M Keesis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

17824 Issued in CA

Practice address

715 Altos Oaks Dr
Los Altos, CA 94024-5402

Phone

(650) 934-7020

NPI assigned

Aug 19, 2010

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1871809574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-934-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245402",
            "telephone_number": "650-934-7020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "795 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943012302",
            "country_code": "US",
            "telephone_number": "650-330-5839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEESIS",
        "first_name": "HEIDI",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-19",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "17824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA17824",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Los Altos, CA
• Providers in Los Altos, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.