Healthcare Provider Details

I. General information

NPI: 1194046565
Provider Name (Legal Business Name): PATRICIA L. KELLER FNP-C, LNS, RN, SANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 N GRANT AVENUE SUITE 200
LOVELAND CO
80538
US

IV. Provider business mailing address

3850 N GRANT AVE STE 200
LOVELAND CO
80538-8431
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-5170
  • Fax: 970-669-7521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0990083
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: