Healthcare Provider Details

I. General information

NPI: 1144840786
Provider Name (Legal Business Name): NICHOLAS FISKE KEELER AG-ACNP, DNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE STE 5015TH
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE STE 5015TH
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-9088
  • Fax: 415-353-3889
Mailing address:
  • Phone: 415-353-9088
  • Fax: 415-353-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95013484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: