Provider Demographics
NPI:1437550167
Name:JACELLARI, KEITHA ANN (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KEITHA
Middle Name:ANN
Last Name:JACELLARI
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:KEITHA
Other - Middle Name:ANN
Other - Last Name:KEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 2452
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-2452
Mailing Address - Country:US
Mailing Address - Phone:870-615-0825
Mailing Address - Fax:
Practice Address - Street 1:1335 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7248
Practice Address - Country:US
Practice Address - Phone:417-363-3900
Practice Address - Fax:417-313-9998
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily