Provider Demographics
NPI:1164454088
Name:WHITNEY, KEYNA JURI (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYNA
Middle Name:JURI
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13675 COURSEY BLVD
Mailing Address - Street 2:APT. 1525
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1344
Mailing Address - Country:US
Mailing Address - Phone:225-751-8165
Mailing Address - Fax:
Practice Address - Street 1:73153 MILITARY RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-6054
Practice Address - Country:US
Practice Address - Phone:985-626-6133
Practice Address - Fax:985-626-6136
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071048Medicaid
LAI50137Medicare UPIN
LA1071048Medicaid