Healthcare Provider Details

I. General information

NPI: 1801210703
Provider Name (Legal Business Name): ANDREA R KELLER MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MICHELLE ROCHE MSN, APRN, NP-C

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1395
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-7164
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15614-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: