Provider Demographics
NPI:1891841995
Name:KELLER, NICOLE M (RN, CNM, APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:RN, CNM, APRN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VANDERBILT DEPT OF OBGYN 1161 21ST AVE S
Mailing Address - Street 2:R-1217 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-322-3385
Mailing Address - Fax:615-343-8806
Practice Address - Street 1:VANDERBILT DEPT OF OBGYN 1161 21ST AVE S
Practice Address - Street 2:R-1217 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-3385
Practice Address - Fax:615-343-8806
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN13243367A00000X
TN123216176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN123216OtherRN