Provider Demographics
NPI:1134841489
Name:KEAL, JENNIFER (CAPRC II)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KEAL
Suffix:
Gender:F
Credentials:CAPRC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46133-7724
Mailing Address - Country:US
Mailing Address - Phone:463-202-5637
Mailing Address - Fax:
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46133-7724
Practice Address - Country:US
Practice Address - Phone:463-202-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist