Healthcare Provider Details

I. General information

NPI: 1487787669
Provider Name (Legal Business Name): PATTI KELLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7562 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-7840
US

IV. Provider business mailing address

7394 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-7802
US

V. Phone/Fax

Practice location:
  • Phone: 352-564-0444
  • Fax: 352-564-4222
Mailing address:
  • Phone: 352-564-0444
  • Fax: 352-564-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberARNP9259474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: