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General NPI Number Information
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NPI Number | 1568047686
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Entity Type | Individual
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Provider Name | JENNIFER L KELLER MSN, BSW, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 127 NH-28 SUITE 3
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City | OSSIPEE
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State | NH
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Zip | 03864
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Country | US
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Telephone | 603-651-8835
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Fax | 603-316-6035
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Provider Business Mailing Address
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Address Line | PO BOX 680
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City | OSSIPEE
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State | NH
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Zip | 03864-0680
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Country | US
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Telephone | 603-651-8835
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 084560-23
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License Number State | NH
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