Healthcare Provider Details

I. General information

NPI: 1295231447
Provider Name (Legal Business Name): DR. JENNIFER L. KEATING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

4109 E BROOKLINE DR
SIOUX FALLS SD
57103-5601
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number67390
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: