Healthcare Provider Details

I. General information

NPI: 1104700541
Provider Name (Legal Business Name): ALEXIS KELLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7902
US

IV. Provider business mailing address

2607 PANCOAST AVE
CINCINNATI OH
45211-7814
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone: 330-933-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN193411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: