Healthcare Provider Details

I. General information

NPI: 1144555665
Provider Name (Legal Business Name): JENNIE MARYANN KELLER M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CENTER AVE
WHITLEY CITY KY
42653-4380
US

IV. Provider business mailing address

PO BOX 652
WHITLEY CITY KY
42653-0652
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-7416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number308423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: