Basic Information
| Provider Information | |||||||||
| NPI: | 1891257242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEYES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | HAS, BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12740 ATLANTIC BLVD STE 8 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322253199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042211577 | ||||||||
| FaxNumber: | 9042211579 | ||||||||
| Practice Location | |||||||||
| Address1: | 12740 ATLANTIC BLVD STE 8 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322253199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042211577 | ||||||||
| FaxNumber: | 9042211579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS5091 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.