Provider Demographics
NPI:1144790015
Name:KEELER, JORDAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 107
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST STE 107
Practice Address - Street 2:SUITE 107
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1428
Practice Address - Country:US
Practice Address - Phone:814-877-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019705363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner