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NPI Code Detail

MEDICARE: JEREMY STEVEN KELLER D.O.

MEDICARE: JEREMY STEVEN KELLER D.O.
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
1207R00000XInternal Medicine Physician03872KY

General Provider Information

NPI Number : 1144667809
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY STEVEN KELLER D.O.
Provider Business Mailing Address
First Line : 333 BEACON HILL RD STE 201
Second Line :
City : MOREHEAD
State : KY
Zip : 40351-6182
Country : US
Telephone Number : 606-780-0444
Fax Number : 606-784-2344
Provider Business Practice Location Address
First Line : 333 BEACON HILL RD STE 201
Second Line :
City : MOREHEAD
State : KY
Zip : 40351-6182
Country : US
Telephone Number : 606-780-0444
Fax Number : 606-784-2344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2013
Last Update Date : 06/11/2024

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