Provider Demographics
NPI:1508805391
Name:KELLER, GAYLE LYNETTE (APRN)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:LYNETTE
Last Name:KELLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:LYNETTE
Other - Last Name:CHRISTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3307 BARADA ST
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2470
Mailing Address - Country:US
Mailing Address - Phone:402-245-4475
Mailing Address - Fax:402-245-6651
Practice Address - Street 1:3307 BARADA ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2470
Practice Address - Country:US
Practice Address - Phone:402-245-4475
Practice Address - Fax:402-245-6651
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851510Medicaid
NE47386OtherBLUE CROSS BLUE SHIELD
NEP66810Medicare UPIN
NE277230Medicare ID - Type Unspecified