Provider Demographics
NPI:1760154280
Name:KEFFELER, RYAN ANTON (FNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANTON
Last Name:KEFFELER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 80TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:ND
Mailing Address - Zip Code:58420
Mailing Address - Country:US
Mailing Address - Phone:701-320-2691
Mailing Address - Fax:
Practice Address - Street 1:800 4TH ST S
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421
Practice Address - Country:US
Practice Address - Phone:701-652-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily