Provider Demographics
NPI:1255026316
Name:KEAGLE, JEANNIE R I
Entity type:Individual
Prefix:MISS
First Name:JEANNIE
Middle Name:R
Last Name:KEAGLE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 JOE TABOR RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-2153
Mailing Address - Country:US
Mailing Address - Phone:931-787-7495
Mailing Address - Fax:
Practice Address - Street 1:2186 JOE TABOR RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38571-2153
Practice Address - Country:US
Practice Address - Phone:931-787-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician