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General NPI Number Information
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NPI Number | 1073678033
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Entity Type | Individual
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Provider Name | MARY JEAN KELLER RN, NP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | MARY KELLER 785 ELKRIDGE LANDING SUITE #300
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City | LINTHICUM HEIGHTS
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State | MD
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Zip | 21090
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Country | US
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Telephone | 417-379-7253
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Fax | 844-464-0583
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65808-4046
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Country | US
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Telephone | 417-269-5712
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Fax | 417-269-7567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 091099
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License Number State | MO
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