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NPI Code Detail

MEDICARE: AUDREY LYNN KELLER PA-C

MEDICARE: AUDREY LYNN KELLER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianCO2225CO
2363A00000XPhysician Assistant5601005193MI
3363A00000XPhysician Assistant22536CA

General Provider Information

NPI Number : 1003991530
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY LYNN KELLER PA-C
Provider Business Mailing Address
First Line : 525 4TH ST
Second Line :
City : BALDWIN
State : MI
Zip : 49304-9518
Country : US
Telephone Number : 231-745-3116
Fax Number : 231-745-3136
Provider Business Practice Location Address
First Line : 525 4TH ST
Second Line :
City : BALDWIN
State : MI
Zip : 49304-9518
Country : US
Telephone Number : 231-745-3116
Fax Number : 231-745-3136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 12/29/2014

Similar Medicare Providers

1376571182 — MATTHEW J STEEL PA
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136
1306875604 — WANDA JEAN OTTINGER PA-C
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136
1295135192 — MICHELLE ELIZABETH GLASGOW MA,LPC,NCC
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136
1447636238 — SHARON BENNER C.P.N.P.
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136
1518482397 — PRISCILLA ANGLEMYER
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136
1578069514 — BALDWIN FAMILY HEALTH CARE
Practice Location Address:
525 4TH ST
BALDWIN, MI
49304-9518
Practice Phone: 231-745-3116
Practice Fax: 231-745-3136

Directions to “ AUDREY LYNN KELLER PA-C” Practice Location

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