Provider Demographics
NPI:1629723077
Name:KEENE, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KEENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 VAL MARIE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2391
Mailing Address - Country:US
Mailing Address - Phone:615-669-6397
Mailing Address - Fax:
Practice Address - Street 1:2520 VAL MARIE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2391
Practice Address - Country:US
Practice Address - Phone:615-669-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst