Healthcare Provider Details

I. General information

NPI: 1033282454
Provider Name (Legal Business Name): ROBERT MICHAEL KELLER JR. ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E CHESTNUT ST
SISSETON SD
57262-1448
US

IV. Provider business mailing address

4414 ESTATE DR
LOUISVILLE KY
40216-5446
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax:
Mailing address:
  • Phone: 502-533-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3592P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: