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General NPI Number Information
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NPI Number | 1952307381
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Entity Type | Individual
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Provider Name | KELLY A KELLER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 420 WHITEHALL RD APT B
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City | ALAMEDA
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State | CA
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Zip | 94501-6135
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Country | US
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Telephone | 510-589-9902
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Fax | 510-263-8565
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Provider Business Mailing Address
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Address Line | 420 WHITEHALL RD UNIT B
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City | ALAMEDA
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State | CA
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Zip | 94501-6135
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Country | US
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Telephone | 510-589-9902
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Fax | 510-263-8565
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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 | 12688
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License Number State | CA
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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 | 12688
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12688
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License Number State | CA
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