Provider Demographics
NPI:1073848248
Name:KEATHLEY, JENNIFER LYNN (MMS,PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:KEATHLEY
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Gender:F
Credentials:MMS,PA-C
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Mailing Address - Street 1:1635 E MYRTLE AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5556
Mailing Address - Country:US
Mailing Address - Phone:602-944-2900
Mailing Address - Fax:602-944-0064
Practice Address - Street 1:1635 E MYRTLE AVE
Practice Address - Street 2:STE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5556
Practice Address - Country:US
Practice Address - Phone:602-944-2900
Practice Address - Fax:602-944-0064
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2022-05-04
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Provider Licenses
StateLicense IDTaxonomies
AZ4511363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical