Provider Demographics
NPI:1588858146
Name:KELLER, JESSICA (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 LEONARD FULGHUM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3793
Mailing Address - Country:US
Mailing Address - Phone:843-856-3262
Mailing Address - Fax:843-856-3268
Practice Address - Street 1:851 LEONARD FULGHUM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3793
Practice Address - Country:US
Practice Address - Phone:843-856-3262
Practice Address - Fax:843-856-3268
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1514DO207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology