Provider Demographics
NPI:1285230441
Name:KEEN, JO ANN
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:KEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:CARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1458 WILSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26617-9770
Mailing Address - Country:US
Mailing Address - Phone:304-651-7672
Mailing Address - Fax:
Practice Address - Street 1:15 BANK ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:15043
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:304-587-9993
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant