Healthcare Provider Details

I. General information

NPI: 1710443544
Provider Name (Legal Business Name): KAYLEE KEENER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S PLEASANT CROSSING BLVD STE 3
ROGERS AR
72758-1495
US

IV. Provider business mailing address

1222 W POPLAR ST
ROGERS AR
72756-4246
US

V. Phone/Fax

Practice location:
  • Phone: 479-278-7414
  • Fax: 479-278-7157
Mailing address:
  • Phone: 501-441-6522
  • Fax: 479-337-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13490
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4823
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-930
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: