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General NPI Number Information
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NPI Number | 1114703725
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Entity Type | Individual
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Provider Name | TRACY KELLER
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Gender | Female
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 13400 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5499
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Country | US
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Telephone | 480-301-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 14857 N DEERSKIN DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2504
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Country | US
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Telephone | 480-330-5969
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Fax |
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | RN115809
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License Number State | AZ
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