MEDICARE: MS. KIERSTIN NOEL KELLER CGC

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
1	170300000X	Genetic Counselor (M.S.)	GC000286	PA

General Provider Information

NPI Number	:	1629435300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIERSTIN NOEL KELLER CGC

Provider Business Mailing Address
First Line	:	3501 CIVIC CENTER BLVD
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA CTRB 6100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3820
Country	:	US
Telephone Number	:	267-425-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 CIVIC CENTER BLVD
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA CTRB 6100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3820
Country	:	US
Telephone Number	:	267-425-3069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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