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General NPI Number Information
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NPI Number | 1780448928
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Entity Type | Individual
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Provider Name | JEANA LEE KEITH APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 6470 S HIGHWAY 27
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City | SOMERSET
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State | KY
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Zip | 42501-6075
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Country | US
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Telephone | 606-341-1339
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Fax |
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Provider Business Mailing Address
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Address Line | 555 JONAH KELSEY RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-8614
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Country | US
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Telephone | 765-580-9603
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4015987
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License Number State | KY
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