Individual
JENNIFER KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2907 S MCINTIRE DR, BLOOMINGTON, IN 47403-4225
(317) 890-2000
(317) 859-7220
Mailing address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 890-2000
(317) 859-7220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002549A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002549A
STATE LICENSE NUMBER
IN
Enumeration date
08/29/2018
Last updated
05/07/2025
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