Healthcare Provider Details

I. General information

NPI: 1669309654
Provider Name (Legal Business Name): ANDREW KELLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

10375 KNOLLSIDE DR
PARKER CO
80134-5777
US

V. Phone/Fax

Practice location:
  • Phone: 720-553-7033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1675415
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: