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NPI Code Detail

MEDICARE: LAQUIETTA CHRISTINA KELLER

MEDICARE: LAQUIETTA CHRISTINA KELLER
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
1172V00000XCommunity Health Worker
2372500000XChore Provider
3374700000XTechnician
43747A0650XAttendant Care Provider
5372600000XAdult Companion

General Provider Information

NPI Number : 1598379547
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAQUIETTA CHRISTINA KELLER
Provider Business Mailing Address
First Line : 4503 REESE RD APT 205
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-1179
Country : US
Telephone Number : 706-304-2288
Fax Number :
Provider Business Practice Location Address
First Line : 4503 REESE RD APT 205
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-1179
Country : US
Telephone Number : 706-304-2288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2020
Last Update Date : 09/06/2020

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Directions to “ LAQUIETTA CHRISTINA KELLER ” Practice Location

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