Provider Demographics
NPI:1568047686
Name:KELLER, JENNIFER L (MSN, BSW, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSN, BSW, PMHNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-0680
Mailing Address - Country:US
Mailing Address - Phone:603-651-8835
Mailing Address - Fax:
Practice Address - Street 1:127 NH-28
Practice Address - Street 2:SUITE 3
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864
Practice Address - Country:US
Practice Address - Phone:603-651-8835
Practice Address - Fax:603-316-6035
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH084560-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health