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NPI Code Detail

MEDICARE: GAYLE LYNETTE KELLER APRN

MEDICARE:   GAYLE LYNETTE KELLER  APRN
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
1363LF0000XFamily Nurse Practitioner110530NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
247386OTHERNEBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1508805391
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAYLE LYNETTE KELLER APRN
Provider Business Mailing Address
First Line : 3307 BARADA ST
Second Line : PO BOX 399
City : FALLS CITY
State : NE
Zip : 68355-2470
Country : US
Telephone Number : 402-245-4475
Fax Number : 402-245-6651
Provider Business Practice Location Address
First Line : 3307 BARADA ST
Second Line :
City : FALLS CITY
State : NE
Zip : 68355-2470
Country : US
Telephone Number : 402-245-4475
Fax Number : 402-245-6651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 09/29/2011

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Directions to “ GAYLE LYNETTE KELLER APRN” Practice Location

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