Provider Demographics
NPI:1437846235
Name:KEENER, JEFFREY ROSS (CPO/LPO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROSS
Last Name:KEENER
Suffix:
Gender:M
Credentials:CPO/LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 UPPER 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3911
Mailing Address - Country:US
Mailing Address - Phone:904-518-0268
Mailing Address - Fax:
Practice Address - Street 1:408 UPPER 36TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3911
Practice Address - Country:US
Practice Address - Phone:904-518-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR266224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist