Healthcare Provider Details

I. General information

NPI: 1316296619
Provider Name (Legal Business Name): PAMELA J KELLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 GOOD HOPE RD
ENOLA PA
17025-1233
US

IV. Provider business mailing address

1824 GOOD HOPE RD
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-8170
  • Fax: 717-221-5398
Mailing address:
  • Phone: 717-988-8170
  • Fax: 717-221-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP012185
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012185
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: