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General NPI Number Information
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NPI Number | 1447512074
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Entity Type | Individual
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Provider Name | KELLER DUNAWAY EARNST FNP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1901 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1101
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Country | US
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Telephone | 704-384-5429
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-749-5800
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17700
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5007246
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License Number State | NC
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