Provider Demographics
NPI:1710524079
Name:BARBOO, KEEGEN JONELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KEEGEN
Middle Name:JONELLE
Last Name:BARBOO
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 1:94 N COCHRANS GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6210
Mailing Address - Country:US
Mailing Address - Phone:808-391-2698
Mailing Address - Fax:
Practice Address - Street 1:6022 FARM TO MARKET RD
Practice Address - Street 2:1488
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:281-583-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant