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General NPI Number Information
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NPI Number | 1679228704
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Entity Type | Individual
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Provider Name | JENNIFER KEIM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 5 INDUSTRIAL DR STE 205
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City | MASHPEE
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State | MA
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Zip | 02649-3465
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Country | US
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Telephone | 774-552-3210
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 W MOUNTAIN VIEW RD APT 2104
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F02220373
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2345077
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License Number State | MA
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