Healthcare Provider Details

I. General information

NPI: 1750184016
Provider Name (Legal Business Name): LAUREN KELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N GIRAUD
COTULLA TX
78014-3113
US

IV. Provider business mailing address

PO BOX 2070
ORANGE GROVE TX
78372-2070
US

V. Phone/Fax

Practice location:
  • Phone: 830-879-2279
  • Fax: 830-879-2235
Mailing address:
  • Phone: 361-382-2024
  • Fax: 855-606-6314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18800
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: