Provider Demographics
NPI:1740653039
Name:KEITH, JENNIFER (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:600 N MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-9313
Mailing Address - Country:US
Mailing Address - Phone:931-268-0218
Mailing Address - Fax:931-268-0872
Practice Address - Street 1:600 N MURRAY ST
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-9313
Practice Address - Country:US
Practice Address - Phone:931-268-0218
Practice Address - Fax:931-268-0872
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000063602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse