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General NPI Number Information
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NPI Number | 1427782861
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Entity Type | Individual
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Provider Name | MARY KELLER PMHNP-BC, RN
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 24 CHECHERO ST STE 2
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City | CLAYTON
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State | GA
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Zip | 30525-6181
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Country | US
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Telephone | 706-963-0654
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Fax | 706-973-4087
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Provider Business Mailing Address
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Address Line | 12244 AUGUSTA RD UNIT 108
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City | LAVONIA
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State | GA
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Zip | 30553-1210
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Country | US
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Telephone | 706-963-0654
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Fax | 706-973-4087
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5019419
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | RN311520
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License Number State | GA
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