Basic Information
| Provider Information | |||||||||
| NPI: | 1841226859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEELY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 BONNIE LANE | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287798511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285865501 | ||||||||
| FaxNumber: | 8285863965 | ||||||||
| Practice Location | |||||||||
| Address1: | 91 TIMBERLANE RD | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287867927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284541098 | ||||||||
| FaxNumber: | 8084549242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 23575 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 47985 | 01 | NC | BCBS OF NORTH CAROLINA | OTHER | 5901909 | 05 | NC | MEDICAID |