Provider Demographics
NPI:1841607421
Name:KEIJNER, WHITLEY RACHEL WARREN
Entity Type:Individual
Prefix:MS
First Name:WHITLEY
Middle Name:RACHEL WARREN
Last Name:KEIJNER
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 1:11824 RANSUM DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2802
Mailing Address - Country:US
Mailing Address - Phone:502-338-0608
Mailing Address - Fax:502-245-1888
Practice Address - Street 1:11824 RANSUM DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2802
Practice Address - Country:US
Practice Address - Phone:502-338-0608
Practice Address - Fax:502-245-1888
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program