Provider Demographics
NPI:1487656989
Name:KELLER, DON LAND (CRNA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:LAND
Last Name:KELLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1837
Mailing Address - Country:US
Mailing Address - Phone:334-294-9342
Mailing Address - Fax:
Practice Address - Street 1:648 PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1837
Practice Address - Country:US
Practice Address - Phone:334-294-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226143367500000X
AL1-091032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3666OtherBLUECROSS BLUESHIELD
FL306849800Medicaid
AL59177497OtherBLUECROSS BLUESHIELD
AL009988575Medicaid
FLP00217034OtherRAILROAD MEDICARE
FLG3666ZMedicare ID - Type Unspecified