Provider Demographics
NPI:1598810210
Name:KEELER, KATHERINE MONICA (WHNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MONICA
Last Name:KEELER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MONICA
Other - Last Name:URAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:877-406-2662
Mailing Address - Fax:
Practice Address - Street 1:3870 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8689
Practice Address - Country:US
Practice Address - Phone:877-406-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004786363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209 004786OtherILLINOIS STATE LISENCE
MO154886OtherMISSOURI STATE LICENSE
MOPENDINGMedicaid