Healthcare Provider Details

I. General information

NPI: 1386327211
Provider Name (Legal Business Name): JULIE BETH KELLER NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 RICHARD ST
MARTINSBURG WV
25404-0651
US

IV. Provider business mailing address

76 RICHARD ST
MARTINSBURG WV
25404-0651
US

V. Phone/Fax

Practice location:
  • Phone: 304-279-8251
  • Fax:
Mailing address:
  • Phone: 304-279-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3783780
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: