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General NPI Number Information
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NPI Number | 1144290784
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Entity Type | Individual
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Provider Name | JENNIFER ANNE KELLER DPM
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 60 SUMMERFIELD CT SUITE 102
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City | ROANOKE
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State | VA
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Zip | 24019-4579
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Country | US
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Telephone | 540-904-1458
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Fax | 855-495-0994
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Provider Business Mailing Address
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Address Line | 60 SUMMERFIELD CT SUITE 102
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City | ROANOKE
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State | VA
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Zip | 24019-4579
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Country | US
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Telephone | 540-904-1458
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Fax | 855-495-0994
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103300725
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License Number State | VA
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