Healthcare Provider Details

I. General information

NPI: 1891841995
Provider Name (Legal Business Name): NICOLE M. KELLER RN, CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VANDERBILT DEPT OF OBGYN 1161 21ST AVE S R-1217 MCN
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

VANDERBILT DEPT OF OBGYN 1161 21ST AVE S R-1217 MCN
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3385
  • Fax: 615-343-8806
Mailing address:
  • Phone: 615-322-3385
  • Fax: 615-343-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN13243
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number123216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: