Healthcare Provider Details

I. General information

NPI: 1801706338
Provider Name (Legal Business Name): MADELINE LOUISE KELLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 12B
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4921 PARKVIEW PL STE 12B
SAINT LOUIS MO
63110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-8103
  • Fax: 314-996-3230
Mailing address:
  • Phone: 314-996-8103
  • Fax: 314-996-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026043488
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: