Healthcare Provider Details

I. General information

NPI: 1467272369
Provider Name (Legal Business Name): JENNA NICOLE KEYS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VICAR PL
DANVILLE VA
24540-1241
US

IV. Provider business mailing address

116 LIPTON LN
DANVILLE VA
24541-4618
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-8372
  • Fax: 434-381-4316
Mailing address:
  • Phone: 571-358-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: