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NPI Code Detail

MEDICARE: KEELY BANKERT

MEDICARE: KEELY BANKERT
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 PractitionerAPRN.CNP.16652OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982008496
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEELY BANKERT
Provider Business Mailing Address
First Line : PO BOX 746071
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6071
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 4235 TUSCARAWAS ST W
Second Line :
City : CANTON
State : OH
Zip : 44708-5424
Country : US
Telephone Number : 234-203-4232
Fax Number : 330-266-4386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2014
Last Update Date : 04/11/2025

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Directions to “ KEELY BANKERT ” Practice Location

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