Healthcare Provider Details

I. General information

NPI: 1417929662
Provider Name (Legal Business Name): BRENDA S KELLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 N CABLE RD
LIMA OH
45805-2133
US

IV. Provider business mailing address

PO BOX 636930
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-2500
  • Fax: 419-996-2509
Mailing address:
  • Phone: 513-981-5123
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP06892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: