Provider Demographics
NPI:1922567973
Name:KEIGHRON, JILLIAN RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:RENEE
Last Name:KEIGHRON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 KINGSLEY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4484
Mailing Address - Country:US
Mailing Address - Phone:904-264-8621
Mailing Address - Fax:
Practice Address - Street 1:1825 KINGSLEY AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4484
Practice Address - Country:US
Practice Address - Phone:904-264-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS18487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program