Basic Information
Provider Information
NPI: 1225366776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEY
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3548
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309143548
CountryCode: US
TelephoneNumber: 7068639595
FaxNumber: 7068688375
Practice Location
Address1: 3647 J DEWEY GRAY CIR STE 200
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309092205
CountryCode: US
TelephoneNumber: 7065049712
FaxNumber: 7065049703
Other Information
ProviderEnumerationDate: 11/20/2009
LastUpdateDate: 10/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XRN084616GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363LC0200XRN084616GAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

No ID Information.


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