Provider Demographics
NPI:1992393375
Name:KEENER, JAMIE L (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:KEENER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 THREE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3127
Mailing Address - Country:US
Mailing Address - Phone:360-578-7387
Mailing Address - Fax:
Practice Address - Street 1:205 THREE RIVERS DR
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3127
Practice Address - Country:US
Practice Address - Phone:360-578-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60328447163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse