MEDICARE: ANDIE KELLER PA-C

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	363A00000X	Physician Assistant	PA16385	TX

General Provider Information

NPI Number	:	1750099966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDIE KELLER PA-C

Provider Business Mailing Address
First Line	:	6210 E HWY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1142
Country	:	US
Telephone Number	:	512-483-9596
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	708 W. BEN WHITE BLVD.
Second Line	:	STE. 210
City	:	AUSTIN
State	:	TX
Zip	:	78704
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-406-7351

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	06/16/2026

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Directions to “ ANDIE KELLER PA-C” Practice Location

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