MEDICARE: DON LAND KELLER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP9226143	FL
2	367500000X	Certified Registered Nurse Anesthetist	1-091032	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00217034	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G3666	OTHER	FL	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	59177497	OTHER	AL	BLUECROSS BLUESHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487656989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DON LAND KELLER CRNA

Provider Business Mailing Address
First Line	:	648 PARK AVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1837
Country	:	US
Telephone Number	:	334-294-9342
Fax Number	:

Provider Business Practice Location Address
First Line	:	648 PARK AVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1837
Country	:	US
Telephone Number	:	334-294-9342
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	06/27/2013

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Directions to “ DON LAND KELLER CRNA” Practice Location

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