Provider Demographics
NPI:1710443544
Name:KEENER, KAYLEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:KEENER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4246
Mailing Address - Country:US
Mailing Address - Phone:501-441-6522
Mailing Address - Fax:479-337-5302
Practice Address - Street 1:1222 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4246
Practice Address - Country:US
Practice Address - Phone:501-441-6522
Practice Address - Fax:479-337-5302
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13490363A00000X
OK4823363A00000X
ARPA-930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1F5971OtherMEDICARE
TXP02599441OtherMCRR
OK200911220AMedicaid
TX410600702Medicaid