Healthcare Provider Details

I. General information

NPI: 1235043308
Provider Name (Legal Business Name): KAMRYN KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3583 N WAGGONER RD
BLACKLICK OH
43004-8731
US

IV. Provider business mailing address

3583 N WAGGONER RD
BLACKLICK OH
43004-8731
US

V. Phone/Fax

Practice location:
  • Phone: 614-584-4389
  • Fax:
Mailing address:
  • Phone: 614-584-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: