Provider Demographics
NPI:1265948749
Name:KEYSER, FONDA JANETTE (PCA)
Entity type:Individual
Prefix:
First Name:FONDA
Middle Name:JANETTE
Last Name:KEYSER
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:FONDA
Other - Middle Name:JANETTE
Other - Last Name:COVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 256
Mailing Address - Street 2:
Mailing Address - City:JEFFREY
Mailing Address - State:WV
Mailing Address - Zip Code:25114
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:963 BIG BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:GREENVIEW
Practice Address - State:WV
Practice Address - Zip Code:25053
Practice Address - Country:US
Practice Address - Phone:304-369-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0032344000OtherPROVIDER ID