Healthcare Provider Details

I. General information

NPI: 1801387451
Provider Name (Legal Business Name): REBEKAH DIANE KELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE B200
LEXINGTON KY
40536-1032
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3533
  • Fax: 859-218-7693
Mailing address:
  • Phone: 314-362-8200
  • Fax: 314-454-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number59992
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2023010939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: