Healthcare Provider Details

I. General information

NPI: 1982592424
Provider Name (Legal Business Name): MEGDALIN ROSE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

IV. Provider business mailing address

518 RIVERVIEW RD PO BOX 603
PONCA NE
68770
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-2477
  • Fax:
Mailing address:
  • Phone: 402-508-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA192428
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: