Provider Demographics
NPI:1629435300
Name:KELLER, KIERSTIN NOEL (CGC)
Entity Type:Individual
Prefix:MS
First Name:KIERSTIN
Middle Name:NOEL
Last Name:KELLER
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CIVIC CENTER BLVD
Mailing Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA CTRB 6100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3820
Mailing Address - Country:US
Mailing Address - Phone:267-425-3069
Mailing Address - Fax:
Practice Address - Street 1:3501 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA CTRB 6100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3820
Practice Address - Country:US
Practice Address - Phone:267-425-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000286170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS