Provider Demographics
NPI:1033989694
Name:JEAN, KEYANNA AZARIA
Entity Type:Individual
Prefix:
First Name:KEYANNA
Middle Name:AZARIA
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HIDDEN RDG APT 2093
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-8233
Mailing Address - Country:US
Mailing Address - Phone:407-985-0614
Mailing Address - Fax:
Practice Address - Street 1:1310 HIDDEN RDG APT 2093
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-8233
Practice Address - Country:US
Practice Address - Phone:407-985-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty