MEDICARE: JESSICA KELLER DNP, FNP-BC, NP-C

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	363LF0000X	Family Nurse Practitioner	APN.0995795-NP	CO
2	363LF0000X	Family Nurse Practitioner	NP95016031	CA
3	163W00000X	Registered Nurse	321958	AZ
4	363L00000X	Nurse Practitioner	321958	AZ
5	163W00000X	Registered Nurse	RN.1668564	CO
6	163W00000X	Registered Nurse	041389604	IL

General Provider Information

NPI Number	:	1952920894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KELLER DNP, FNP-BC, NP-C

Provider Business Mailing Address
First Line	:	2 UPPER RAGSDALE DR STE B210
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7851
Country	:	US
Telephone Number	:	831-333-0999
Fax Number	:	831-333-0909

Provider Business Practice Location Address
First Line	:	9111 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2515
Country	:	US
Telephone Number	:	602-747-4000
Fax Number	:

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

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	01/20/2026

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