Healthcare Provider Details

I. General information

NPI: 1124952429
Provider Name (Legal Business Name): JAYNA KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 3RD ST
PONCA NE
68770-0603
US

IV. Provider business mailing address

PO BOX 603
PONCA NE
68770-0603
US

V. Phone/Fax

Practice location:
  • Phone: 402-755-2216
  • Fax:
Mailing address:
  • Phone: 402-755-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number722
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: