MEDICARE: JENNIFER ANNE KELLER DPM

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
1	213E00000X	Podiatrist	0103300725	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480032174	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144290784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE KELLER DPM

Provider Business Mailing Address
First Line	:	60 SUMMERFIELD CT
Second Line	:	SUITE 102
City	:	ROANOKE
State	:	VA
Zip	:	24019-4579
Country	:	US
Telephone Number	:	540-904-1458
Fax Number	:	855-495-0994

Provider Business Practice Location Address
First Line	:	60 SUMMERFIELD CT
Second Line	:	SUITE 102
City	:	ROANOKE
State	:	VA
Zip	:	24019-4579
Country	:	US
Telephone Number	:	540-904-1458
Fax Number	:	855-495-0994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/06/2014

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