Provider Demographics
NPI:1477136802
Name:KELLER, ASHLEY LUANN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LUANN
Last Name:KELLER
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 1:45 E RIVER PARK PL W STE 507
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1565
Mailing Address - Country:US
Mailing Address - Phone:865-635-1806
Mailing Address - Fax:
Practice Address - Street 1:45 E RIVER PARK PL W STE 507
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1565
Practice Address - Country:US
Practice Address - Phone:559-492-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant