Provider Demographics
NPI:1609849108
Name:KEITH, JANA R (WHNP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:R
Last Name:KEITH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 EAGLE DAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-3605
Mailing Address - Country:US
Mailing Address - Phone:601-736-6137
Mailing Address - Fax:601-731-1383
Practice Address - Street 1:551 EAGLE DAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3605
Practice Address - Country:US
Practice Address - Phone:601-736-6137
Practice Address - Fax:601-731-1383
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR606456363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118930Medicaid
S46551Medicare UPIN
MS00118930Medicaid