MEDICARE: JAYSON TRAVIS KEENER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9111420	FL
2	363A00000X	Physician Assistant	50.006494RX	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821575432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSON TRAVIS KEENER PA-C

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE STE 2
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 HAPPY HOLLOW RD
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-1848
Country	:	US
Telephone Number	:	513-327-9244
Fax Number	:	513-323-5201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	10/11/2023

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Directions to “ JAYSON TRAVIS KEENER PA-C” Practice Location

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