Healthcare Provider Details

I. General information

NPI: 1497640593
Provider Name (Legal Business Name): DAVETTE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 W 49TH ST STE 201
SIOUX FALLS SD
57106-5221
US

IV. Provider business mailing address

4009 W 49TH ST STE 201
SIOUX FALLS SD
57106-5221
US

V. Phone/Fax

Practice location:
  • Phone: 218-336-4948
  • Fax: 833-660-2069
Mailing address:
  • Phone: 218-336-4948
  • Fax: 833-660-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number27653
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: