Healthcare Provider Details

I. General information

NPI: 1184497976
Provider Name (Legal Business Name): JULIA KECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA OLSEN

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 FAR HILLS AVE
DAYTON OH
45429-2211
US

IV. Provider business mailing address

719 REDFOX RD
FINDLAY OH
45840-7125
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-5954
  • Fax:
Mailing address:
  • Phone: 419-577-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: