Provider Demographics
NPI:1114603636
Name:KEENER, JOSHUA I
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:I
Last Name:KEENER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 AVE OF THE OAKS UNIT 309S
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4914
Mailing Address - Country:US
Mailing Address - Phone:209-687-9271
Mailing Address - Fax:
Practice Address - Street 1:1125 AVE OF THE OAKS UNIT 309S
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4914
Practice Address - Country:US
Practice Address - Phone:209-687-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician