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General NPI Number Information
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NPI Number | 1639458870
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Entity Type | Individual
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Provider Name | JULIE MARIE KELLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 4414 LAKE BOONE TRL SUITE 402
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City | RALEIGH
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State | NC
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Zip | 27607-7513
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Country | US
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Telephone | 919-784-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 9240 BRUCKHAUS ST APARTMENT 2-315
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City | RALEIGH
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State | NC
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Zip | 27617-4401
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Country | US
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Telephone | 919-880-1751
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-03041
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License Number State | NC
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