Provider Demographics
NPI:1821575432
Name:KEENER, JAYSON TRAVIS (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:TRAVIS
Last Name:KEENER
Suffix:
Gender:M
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 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5817 HAPPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1848
Practice Address - Country:US
Practice Address - Phone:513-327-9244
Practice Address - Fax:513-323-5201
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111420363A00000X
OH50.006494RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant