Healthcare Provider Details

I. General information

NPI: 1487656989
Provider Name (Legal Business Name): DON LAND KELLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 PARK AVE
MONTGOMERY AL
36106-1837
US

IV. Provider business mailing address

648 PARK AVE
MONTGOMERY AL
36106-1837
US

V. Phone/Fax

Practice location:
  • Phone: 334-294-9342
  • Fax:
Mailing address:
  • Phone: 334-294-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9226143
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-091032
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: