Healthcare Provider Details

I. General information

NPI: 1992622518
Provider Name (Legal Business Name): ALEXANDRIA KELLER BSN,RN,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX KELLER

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 W MAIN ST # 178
TROY OH
45373-2303
US

IV. Provider business mailing address

1841 W MAIN ST # 178
TROY OH
45373-2303
US

V. Phone/Fax

Practice location:
  • Phone: 937-216-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.419143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: