Fort, Keith Wesley

Fort, Keith Wesley is an individual health care provider with primary practice located at 2400 Mount Zion Pkwy Kaiser Permanente Southwood Medical Center, Jonesboro GA 30236-2500. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Fort, Keith Wesley can be contacted via phone (201) 943-9100.

Contact Information

Primary practice address
2400 Mount Zion Pkwy Kaiser Permanente Southwood Medical Center Jonesboro GA 30236-2500
Phone: (201) 943-9100
Fax: (201) 943-7308
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 6400 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 25MP00214500 New Jersey
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 006400 Georgia

Profile Details

NPI number 1487888061
LBN Legal business name Fort, Keith Wesley
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2009
Last updated Jan 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487888061 NPPES
New Jersey Other 162546NMS MEDICARE PTAN

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