Provider Demographics
NPI:1003544776
Name:KELLER, RICKY
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10235 N 31ST ST UNIT 16
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3829
Mailing Address - Country:US
Mailing Address - Phone:573-380-8637
Mailing Address - Fax:
Practice Address - Street 1:10235 N 31ST ST UNIT 16
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3829
Practice Address - Country:US
Practice Address - Phone:573-380-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care