Healthcare Provider Details

I. General information

NPI: 1528659737
Provider Name (Legal Business Name): MIA G KELLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA G ORR NP

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 S HOLLY CIR STE 304
CENTENNIAL CO
80112-1045
US

IV. Provider business mailing address

6909 S HOLLY CIR STE 304
CENTENNIAL CO
80112-1045
US

V. Phone/Fax

Practice location:
  • Phone: 720-729-7372
  • Fax: 720-202-1681
Mailing address:
  • Phone: 720-729-7372
  • Fax: 720-202-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997865-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAPN.0997865-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: