Provider Demographics
NPI:1053062240
Name:KELLER, STEPHANIE STRUNZ (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:STRUNZ
Last Name:KELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10009 FLINT COAST WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2195
Mailing Address - Country:US
Mailing Address - Phone:407-403-2421
Mailing Address - Fax:
Practice Address - Street 1:8712 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-4501
Practice Address - Country:US
Practice Address - Phone:865-932-3633
Practice Address - Fax:865-932-3316
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4845363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical