Provider Demographics
NPI:1629463476
Name:KEYTON, JENNIFER (CPHT, RPHT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KEYTON
Suffix:
Gender:F
Credentials:CPHT, RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4105
Mailing Address - Country:US
Mailing Address - Phone:434-465-1481
Mailing Address - Fax:
Practice Address - Street 1:2003 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4105
Practice Address - Country:US
Practice Address - Phone:434-465-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA47-3556473171M00000X
VA0230003353183700000X
VA440101080550538183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No183700000XPharmacy Service ProvidersPharmacy Technician