Provider Demographics
NPI:1265224612
Name:KEENER, TYREN DAVID
Entity type:Individual
Prefix:
First Name:TYREN
Middle Name:DAVID
Last Name:KEENER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 WADDLE ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5416
Mailing Address - Country:US
Mailing Address - Phone:479-410-7495
Mailing Address - Fax:
Practice Address - Street 1:579 WADDLE ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5416
Practice Address - Country:US
Practice Address - Phone:479-410-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRBT-25-437975106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician