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NPI Code Detail

MEDICARE: JOHN VINCENT KELLER PA

MEDICARE: JOHN VINCENT KELLER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-07051NC

General Provider Information

NPI Number : 1316488463
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN VINCENT KELLER PA
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 107 S CENTER ST
Second Line :
City : HILDEBRAN
State : NC
Zip : 28637-8304
Country : US
Telephone Number : 828-397-3522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2017
Last Update Date : 04/11/2023

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