Provider Demographics
NPI:1508868126
Name:KELLER, BRITTANY L (CRNA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LYNNE
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 660257
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0257
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:3283 MALCOLM DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-8816
Practice Address - Country:US
Practice Address - Phone:334-356-9970
Practice Address - Fax:334-356-9873
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226034367500000X
AL1-107535367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306926500Medicaid
AL59178101OtherBLUECROSS BLUESHIELD
FLG3673OtherBLUECROSS BLUESHIELD
AL009994005Medicaid
FLG3673ZMedicare ID - Type Unspecified